Healthcare Provider Details

I. General information

NPI: 1437363785
Provider Name (Legal Business Name): WENDY CLAYTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 NORTHTOWN DR
JACKSON MS
39211-3047
US

IV. Provider business mailing address

50 YORKTOWN PT
PETAL MS
39465-4250
US

V. Phone/Fax

Practice location:
  • Phone: 601-606-5475
  • Fax: 601-606-5475
Mailing address:
  • Phone: 601-606-5475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT2352
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: