MEDICARE: WENDY PEMBERTON

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	224Z00000X	Occupational Therapy Assistant	0000667	CO

General Provider Information

NPI Number	:	1598135618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY PEMBERTON

Provider Business Mailing Address
First Line	:	1454 NEWPORT ST
Second Line	:	APT 3
City	:	DENVER
State	:	CO
Zip	:	80220-2900
Country	:	US
Telephone Number	:	402-740-2726
Fax Number	:

Provider Business Practice Location Address
First Line	:	1454 NEWPORT ST
Second Line	:	APT 3
City	:	DENVER
State	:	CO
Zip	:	80220-2900
Country	:	US
Telephone Number	:	402-740-2726
Fax Number	:

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

Provider Enumeration Date	:	10/01/2015
Last Update Date	:	10/01/2015

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Directions to “ WENDY PEMBERTON ” Practice Location

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