Kennedy Ann Wambolt, OTR

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

125966 Issued in TX

Practice address

1408 Cindy St
Frederick, OK 73542-1604

Phone

(580) 305-2988

NPI assigned

Jul 24, 2026

Last updated

Jul 24, 2026By 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

Practice roles

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

• Full Circle Therapy

  • Occupational Therapist
  • Frederick, OK
  • NPI 1073434064
  NPD (past) Authorized official

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

{
    "created_epoch": "1784851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784851200000",
    "number": "1972424968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1408 CINDY ST",
            "city": "FREDERICK",
            "state": "OK",
            "postal_code": "735421604",
            "telephone_number": "580-305-2988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1408 CINDY ST",
            "city": "FREDERICK",
            "state": "OK",
            "postal_code": "735421604",
            "telephone_number": "580-305-2988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAMBOLT",
        "first_name": "KENNEDY",
        "middle_name": "ANN",
        "credential": "OTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2026-07-24",
        "last_updated": "2026-07-24",
        "certification_date": "2026-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": "TX",
            "license": "125966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sultan LLC
• Hassen Thompson
• Tillman County Oklahoma Emergency
• Cheyenne Sommer Valenzuela
• Linda M Valenzuela
• Jason Lyn Wilson, M.ED, LPC

• Occupational Therapist in Frederick, OK
• Providers in Frederick, OK by specialty
• Occupational Therapist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2026; 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.