Provider Demographics
NPI:1427315027
Name:OVERFIELD, KENDRA (OTR/L)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:OVERFIELD
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 1:4012 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2824
Mailing Address - Country:US
Mailing Address - Phone:850-807-4050
Mailing Address - Fax:
Practice Address - Street 1:4012 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2824
Practice Address - Country:US
Practice Address - Phone:850-807-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008184225X00000X
FL16485225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30435OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI30435OtherBLUE CROSS BLUE SHIELD OF MICHIGAN