Kendy R Polley, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

057.004923 Issued in IL

Practice address

1050 N Reed Station Rd
Carbondale, IL 62902-7376

Phone

(618) 519-9590

NPI assigned

Jan 29, 2020

Last updated

Jan 29, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

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

{
    "created_epoch": "1580256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580256000000",
    "number": "1922639954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 OLIVIA DR",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629591388",
            "telephone_number": "618-771-2141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 N REED STATION RD",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629027376",
            "telephone_number": "618-519-9590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLLEY",
        "first_name": "KENDY",
        "middle_name": "R",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-29",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "IL",
            "license": "057.004923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Planned Parenthood of Illinois
• Paul F Ploegman, M.D.
• Monika A Plumb, PHD
• Kelsey Elainea Podnar, PHARM.D
• Mary Michaels Pohlmann, M.D.
• Shawna Marie Pope, CCC/SLP
• Catherine J Porter, CRNA
• Jennifer Lynn Porter
• Thomas Steven Portner, PT
• Katherine Poulos, PHARM D

• Occupational Therapy Assistant in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Occupational Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 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.