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General NPI Number Information
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NPI Number | 1194606905
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Entity Type | Individual
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Provider Name | MAKAYLA WENTWORTH OTD, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 308 E LANCASTER AVE STE 315
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City | WYNNEWOOD
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State | PA
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Zip | 19096-2150
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Country | US
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Telephone | 215-275-8710
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 BENJAMIN FRANKLIN PKWY APT S1605
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City | PHILADELPHIA
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State | PA
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Zip | 19130-3618
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Country | US
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Telephone |
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OC020967
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License Number State | PA
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