Provider Demographics
NPI:1285316646
Name:JOHNSTON, KENDRA ELAINE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:ELAINE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:ELAINE
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 TOWNE CENTRE DR APT 104
Mailing Address - Street 2:
Mailing Address - City:HERMON
Mailing Address - State:ME
Mailing Address - Zip Code:04401-0647
Mailing Address - Country:US
Mailing Address - Phone:207-745-7221
Mailing Address - Fax:
Practice Address - Street 1:2042 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:HERMON
Practice Address - State:ME
Practice Address - Zip Code:04401-0247
Practice Address - Country:US
Practice Address - Phone:207-316-3417
Practice Address - Fax:207-605-0260
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT4485225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist