MEDICARE: WENDI RAYLENE WINGATE JONES OTR/L MA

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
1	225X00000X	Occupational Therapist	104328	MN

General Provider Information

NPI Number	:	1952831992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDI RAYLENE WINGATE JONES OTR/L MA

Provider Business Mailing Address
First Line	:	429 20TH AVE N
Second Line	:
City	:	SARTELL
State	:	MN
Zip	:	56377-1687
Country	:	US
Telephone Number	:	218-969-1313
Fax Number	:

Provider Business Practice Location Address
First Line	:	142 1ST ST N
Second Line	:
City	:	WAITE PARK
State	:	MN
Zip	:	56387-1273
Country	:	US
Telephone Number	:	320-257-4931
Fax Number	:	320-253-1170

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2017
Last Update Date	:	06/13/2017

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