Cailin Grace Kennedy, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

31007088A Issued in IN

Practice address

2505 E Jefferson Blvd
South Bend, IN 46615-2635

Phone

(574) 289-4831

NPI assigned

Feb 13, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Logan Community Resources, Inc.

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • South Bend, IN
  • NPI 1891917449
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581552000000",
    "number": "1396378774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2435 CENTRAL PARK DR N APT 311",
            "city": "PLAINFIELD",
            "state": "IN",
            "postal_code": "461682671",
            "telephone_number": "812-345-7997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 E JEFFERSON BLVD",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466152635",
            "telephone_number": "574-289-4831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "CAILIN",
        "middle_name": "GRACE",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-13",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IN",
            "license": "31007088A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick Kelly, COTA
• Starr E Kelly, O.T.
• Kathleen Kelsey, LCSW
• Brian Kemp
• Sydney Kempf
• Stephen D Kennedy, D.O.
• Kathryn Anne Kenney, D.O., MBA
• Jena Ruth Kern, MD
• Nicholas Harold Kerr, DO
• Kristen Anne Kertesz, MA

• Occupational Therapist in South Bend, IN
• Providers in South Bend, IN by specialty
• Occupational Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.