Provider Demographics
NPI:1902499841
Name:PETERSEN, KENDRA NICOLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:NICOLE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3234 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2538
Mailing Address - Country:US
Mailing Address - Phone:858-414-1250
Mailing Address - Fax:
Practice Address - Street 1:3234 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2538
Practice Address - Country:US
Practice Address - Phone:858-414-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0006634225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist