Healthcare Provider Details

I. General information

NPI: 1740362995
Provider Name (Legal Business Name): WENDY SUZANNE MACNEILL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WENDY SUZANNE ALLEN

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8823 PRODUCTION LN
OOLTEWAH TN
37363-6511
US

IV. Provider business mailing address

13919 W 71ST PL
SHAWNEE KS
66216-5502
US

V. Phone/Fax

Practice location:
  • Phone: 423-238-7217
  • Fax: 423-238-3473
Mailing address:
  • Phone: 816-665-8137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number004553
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number17-01687
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: