Healthcare Provider Details

I. General information

NPI: 1649477704
Provider Name (Legal Business Name): WENDY L MEGUESS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WENDY L KOLBET OTR

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 W PINE AVE
MERIDIAN ID
83642-5031
US

IV. Provider business mailing address

12312 W ENGELMANN DR
BOISE ID
83713-1416
US

V. Phone/Fax

Practice location:
  • Phone: 208-895-6431
  • Fax: 208-887-1204
Mailing address:
  • Phone: 208-705-7438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00003557
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT-1058
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: