Individual
MR. JUSTIN W KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
8640 REVERE CT, MIDLAND, GA 31820-4223
(706) 577-4591
Mailing address
8640 REVERE CT, MIDLAND, GA 31820-4223
(706) 577-4591
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
4032
AL
225X00000X
Occupational Therapist
Primary
OT006206
GA
Other
Enumeration date
10/12/2016
Last updated
10/12/2016
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