Provider Demographics
NPI:1558180505
Name:KENNETZ KIDS OT
Entity type:Organization
Organization Name:KENNETZ KIDS OT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:PENAFLOR
Authorized Official - Last Name:KENNETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-687-8233
Mailing Address - Street 1:5067 FARMLAND WAY
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38002-2510
Mailing Address - Country:US
Mailing Address - Phone:901-687-8233
Mailing Address - Fax:
Practice Address - Street 1:5067 FARMLAND WAY
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38002-2510
Practice Address - Country:US
Practice Address - Phone:901-687-8233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty