Provider Demographics
NPI:1932844602
Name:SNODGRASS, KENNEDY PAIGE (COTA/L)
Entity type:Individual
Prefix:MISS
First Name:KENNEDY
Middle Name:PAIGE
Last Name:SNODGRASS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203
Mailing Address - Street 2:2203 HOPE LANE
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761
Mailing Address - Country:US
Mailing Address - Phone:417-621-5119
Mailing Address - Fax:
Practice Address - Street 1:302 W 2ND ST
Practice Address - Street 2:
Practice Address - City:GENTRY
Practice Address - State:AR
Practice Address - Zip Code:72734-5502
Practice Address - Country:US
Practice Address - Phone:479-736-2252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-AA1833224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant