Provider Demographics
NPI:1861625725
Name:KENNEDY, CAROL CHRISTINE (OTR/L)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:CHRISTINE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:CHRISTINE
Other - Last Name:REINISCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 SE OAK ST
Mailing Address - Street 2:SUITE #202
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4285
Mailing Address - Country:US
Mailing Address - Phone:503-648-9565
Mailing Address - Fax:503-648-1282
Practice Address - Street 1:900 SE OAK ST
Practice Address - Street 2:SUITE #202
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4285
Practice Address - Country:US
Practice Address - Phone:503-648-9565
Practice Address - Fax:503-648-1282
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR340463225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist