Provider Demographics
NPI:1346497104
Name:TYNDALL, KATHRYN CANFIELD (OTR)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:CANFIELD
Last Name:TYNDALL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 DAKOTA ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6842
Mailing Address - Country:US
Mailing Address - Phone:505-265-6430
Mailing Address - Fax:
Practice Address - Street 1:10500 ACADEMY RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-7306
Practice Address - Country:US
Practice Address - Phone:505-217-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-24
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOT3938225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist