Provider Demographics
NPI:1982105359
Name:KENNDE, JUSTINA AMEWIE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:JUSTINA
Middle Name:AMEWIE
Last Name:KENNDE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:JUSTINA
Other - Middle Name:AMEWIE
Other - Last Name:IDOKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:8450 WILL CLAYTON PKWY
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-5830
Mailing Address - Country:US
Mailing Address - Phone:281-446-8484
Mailing Address - Fax:
Practice Address - Street 1:8450 WILL CLAYTON PKWY
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5830
Practice Address - Country:US
Practice Address - Phone:281-446-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116177225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist