Provider Demographics
NPI:1720880636
Name:KENNISON, MICHAEL (OT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KENNISON
Suffix:
Gender:
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 WHEELER RD APT B
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-2870
Mailing Address - Country:US
Mailing Address - Phone:314-374-9681
Mailing Address - Fax:
Practice Address - Street 1:1909 WHEELER RD APT B
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-2870
Practice Address - Country:US
Practice Address - Phone:314-374-9681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22687225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist