Provider Demographics
NPI:1093574154
Name:YOUNGBERG, WENDY L (OTR/L)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:L
Last Name:YOUNGBERG
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 1:109 SPLIT RAIL DR
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-7192
Mailing Address - Country:US
Mailing Address - Phone:417-825-9690
Mailing Address - Fax:
Practice Address - Street 1:1335 NW BROAD ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-4428
Practice Address - Country:US
Practice Address - Phone:888-362-8704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001489225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist