Individual
MR. EDDIE LEELOVE KUYKENDALL III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
13835 N TATUM BLVD, STE 9-429, PHOENIX, AZ 85032-5590
(480) 242-5903
Mailing address
7519 N 47TH LN, GLENDALE, AZ 85301-1576
(602) 301-5592
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3353
AZ
Other
Enumeration date
07/16/2010
Last updated
12/10/2013
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