Provider Demographics
NPI:1386769230
Name:KENNEDY, LORI (OT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 BROKEN FENCE RD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-9607
Mailing Address - Country:US
Mailing Address - Phone:303-601-6666
Mailing Address - Fax:303-447-3390
Practice Address - Street 1:2750 BROADWAY ST
Practice Address - Street 2:PT
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3573
Practice Address - Country:US
Practice Address - Phone:303-601-6666
Practice Address - Fax:303-447-3390
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2289225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist