Provider Demographics
NPI:1992920037
Name:GLEASON, KENDRA DEE (OTR)
Entity type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:DEE
Last Name:GLEASON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:KENDRA
Other - Middle Name:DEE
Other - Last Name:HOTALING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:19 VANDIDOORT DR UNIT 2A
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3648
Mailing Address - Country:US
Mailing Address - Phone:845-440-7450
Mailing Address - Fax:845-440-7450
Practice Address - Street 1:22 ROBERT R KASIN WAY
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-1559
Practice Address - Country:US
Practice Address - Phone:845-831-8704
Practice Address - Fax:845-831-1124
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013549-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist