Active NPI
Kenna Bondoc, COTA
- Occupational Therapy Assistant
- Russellville, AR
National Provider Identifier
1992135487
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- O-T1370
- Practice address
- 500 E 3Rd St
Russellville, AR 72801-5204 - Phone
- (479) 968-1198
- Fax
- (479) 967-1178
- NPI assigned
- Nov 19, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | O-T1370 | AR | Primary |
Addresses
Primary practice location
500 E 3Rd St
Russellville, AR 72801-5204
Mailing address
3345 Homestead Rd
Conway, AR 72032-9148
Phone (870) 820-1431
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| O-T1370 | AR | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1384819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384819200000",
"number": "1992135487",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3345 HOMESTEAD RD",
"city": "CONWAY",
"state": "AR",
"postal_code": "720329148",
"telephone_number": "870-820-1431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 E 3RD ST",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728015204",
"telephone_number": "479-968-1198",
"fax_number": "479-967-1178"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONDOC",
"first_name": "KENNA",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-11-19",
"last_updated": "2013-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "AR",
"license": "O-T1370",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Russellville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.