Individual
STEPHANIE A KENNEALLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
40 CANTERBURY DR, FREEHOLD, NJ 07728-4421
(732) 266-8814
Mailing address
257B MATCHAPONIX AVE, MONROE, NJ 08831-4034
(732) 266-8814
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
46TR0542000
NJ
Other
Enumeration date
10/15/2011
Last updated
04/09/2019
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