Provider Demographics
NPI:1861766453
Name:KENNEDY, JOYCE P (OT)
Entity type:Individual
Prefix:MISS
First Name:JOYCE
Middle Name:P
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:618 MAIN ST
Mailing Address - Street 2:GOODWILL INDUSTRIES OF NNE
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240
Mailing Address - Country:US
Mailing Address - Phone:207-795-6110
Mailing Address - Fax:207-795-6189
Practice Address - Street 1:618 MAIN ST
Practice Address - Street 2:GOODWILL INDUSTRIES OF NNE
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-795-6110
Practice Address - Fax:207-795-6189
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2613225XN1300X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics