Provider Demographics
NPI:1285949248
Name:KENNEDY, KATHLEEN RUTH (OTR/L)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:RUTH
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:BELVEDERE
Mailing Address - State:SC
Mailing Address - Zip Code:29841-2422
Mailing Address - Country:US
Mailing Address - Phone:803-278-1592
Mailing Address - Fax:803-442-6276
Practice Address - Street 1:131 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:BELVEDERE
Practice Address - State:SC
Practice Address - Zip Code:29841-2422
Practice Address - Country:US
Practice Address - Phone:803-278-1592
Practice Address - Fax:803-442-6276
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-15
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000230225X00000X
SC177225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist