Provider Demographics
NPI:1225276710
Name:BANKHEAD, KENDRICK LAMON
Entity type:Individual
Prefix:
First Name:KENDRICK
Middle Name:LAMON
Last Name:BANKHEAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7009 ALMEDA RD APT 1520
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2183
Mailing Address - Country:US
Mailing Address - Phone:601-813-8314
Mailing Address - Fax:
Practice Address - Street 1:7009 ALMEDA RD APT 1520
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2183
Practice Address - Country:US
Practice Address - Phone:601-813-8314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112894225X00000X
MSOT2236225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist