Provider Demographics
NPI:1306693163
Name:FORD, KENNETH ROBERT
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:ROBERT
Last Name:FORD
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 1:7427 S SOUTH SHORE DR APT 2D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-3815
Mailing Address - Country:US
Mailing Address - Phone:630-561-4540
Mailing Address - Fax:
Practice Address - Street 1:1440 W TAYLOR ST # 1290
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4623
Practice Address - Country:US
Practice Address - Phone:630-561-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantDriving and Community Mobility