Provider Demographics
NPI:1679938906
Name:DAMCOTT, KENNETH L JR (OTR/L)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:L
Last Name:DAMCOTT
Suffix:JR
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-3013
Mailing Address - Country:US
Mailing Address - Phone:814-323-0173
Mailing Address - Fax:
Practice Address - Street 1:2301 EDINBORO RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-3409
Practice Address - Country:US
Practice Address - Phone:814-860-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC007419L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist