Provider Demographics
NPI:1447480272
Name:KIRKENDALL, JOYCELYN LOUISE (OTR)
Entity type:Individual
Prefix:
First Name:JOYCELYN
Middle Name:LOUISE
Last Name:KIRKENDALL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4080 NELSON RD STE 500
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2440
Mailing Address - Country:US
Mailing Address - Phone:337-497-0434
Mailing Address - Fax:337-494-7548
Practice Address - Street 1:4080 NELSON RD STE 400
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2439
Practice Address - Country:US
Practice Address - Phone:337-497-0434
Practice Address - Fax:337-494-7548
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.200423225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA12405653OtherCAQH