Provider Demographics
NPI:1962696070
Name:KENNEDY, SARAH (OTR/L)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:5207 SQUIRES COUTY
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-8551
Mailing Address - Country:US
Mailing Address - Phone:434-401-5019
Mailing Address - Fax:434-316-0253
Practice Address - Street 1:200 LILLIAN LN
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4378
Practice Address - Country:US
Practice Address - Phone:434-316-0254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002424225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist