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General NPI Number Information
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NPI Number | 1053130955
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Entity Type | Individual
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Provider Name | WENDY SUE PLOURD
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Gender | Female
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 350 CLYDE MORRIS BLVD
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5993
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Country | US
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Telephone | 386-269-8458
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 OAK FOREST CIR
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City | PORT ORANGE
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State | FL
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Zip | 32129-4178
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Country | US
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Telephone | 678-760-6030
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 17804
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License Number State | FL
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