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NPI Code Detail

MEDICARE: DANITA LYNNE WENDORF OTR

MEDICARE: DANITA LYNNE WENDORF OTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist2098WI

General Provider Information

NPI Number : 1417035379
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANITA LYNNE WENDORF OTR
Provider Business Mailing Address
First Line : 1858 N COMMERCE ST
Second Line : APT. 802
City : MILWAUKEE
State : WI
Zip : 53212-3767
Country : US
Telephone Number : 414-374-1014
Fax Number :
Provider Business Practice Location Address
First Line : 833 N 26TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53233-1507
Country : US
Telephone Number : 414-344-7676
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 04/29/2015

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Directions to “ DANITA LYNNE WENDORF OTR” Practice Location

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