Individual
KENDRA LEE ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
36 S SUMAC DR, JANESVILLE, WI 53545-2135
(608) 751-2029
Mailing address
36 S SUMAC DR, JANESVILLE, WI 53545-2135
(608) 751-2029
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.003179
IL
224Z00000X
Occupational Therapy Assistant
4723-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057.003179
STATE LICENSE
IL
01
—
4729-027
STATE LICENSE
WI
Enumeration date
11/09/2009
Last updated
12/05/2012
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