Individual
DAVIE MICHELLE KENNINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
1100 SARAH SWAMY LN, SHERMAN, TX 75090
(903) 647-1102
Mailing address
4100 N PARKDALE LN APT 2304, DENISON, TX 75020-0051
(903) 647-1102
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
209882
TX
224Z00000X
Occupational Therapy Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209882
SELF
TX
Enumeration date
10/15/2020
Last updated
10/15/2020
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