Provider Demographics
NPI:1043489305
Name:MITCHELL, WENDY (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5990 SWAN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-6310
Mailing Address - Country:US
Mailing Address - Phone:989-992-5994
Mailing Address - Fax:734-895-6236
Practice Address - Street 1:5990 SWAN LAKE DR
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-6310
Practice Address - Country:US
Practice Address - Phone:989-992-5994
Practice Address - Fax:734-895-6236
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006920225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist