Individual
MALLORY KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4216 NE 24TH AVE, PORTLAND, OR 97211-6414
(845) 893-7389
Mailing address
4216 NE 24TH AVE, PORTLAND, OR 97211-6414
(845) 893-7389
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
233754
OR
Other
Enumeration date
04/04/2012
Last updated
04/11/2024
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