MEDICARE: MR. ROBERT E WENSLEY ORTHOTIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	C22358	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528272002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT E WENSLEY ORTHOTIST

Provider Business Mailing Address
First Line	:	3641 WESTGATE CENTER CIR
Second Line	:	SUITE B
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-2936
Country	:	US
Telephone Number	:	336-725-4555
Fax Number	:	336-725-4556

Provider Business Practice Location Address
First Line	:	3641 WESTGATE CENTER CIR
Second Line	:	SUITE B
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-2936
Country	:	US
Telephone Number	:	336-725-4555
Fax Number	:	336-725-4556

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2013

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