Provider Demographics
NPI:1285283341
Name:KENENDY, SAVANNAH CATHERINE (COTA)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:CATHERINE
Last Name:KENENDY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 S 13TH ST APT 407
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-7805
Mailing Address - Country:US
Mailing Address - Phone:318-368-5430
Mailing Address - Fax:
Practice Address - Street 1:763 MARLANDWOOD RD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3573
Practice Address - Country:US
Practice Address - Phone:254-771-5950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215734224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant