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General NPI Number Information
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NPI Number | 1790042240
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Entity Type | Individual
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Provider Name | WENDY JENKINS GRIMMETT MS, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/20/2012
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Last Update Date | 04/20/2012
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Provider Practice Location Address
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Address Line | 1315 WALNUT ST
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City | TEXARKANA
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State | TX
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Zip | 75501-4446
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Country | US
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Telephone | 903-794-2705
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Fax | 903-793-1203
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Provider Business Mailing Address
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Address Line | 712 LAFAYETTE 23
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City | BUCKNER
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State | AR
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Zip | 71827-9514
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Country | US
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Telephone | 870-533-2073
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Fax | 870-533-2073
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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 | 113278
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License Number State | TX
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