Provider Demographics
NPI:1093904138
Name:MULLIGAN, WENDI WOODS (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:WENDI
Middle Name:WOODS
Last Name:MULLIGAN
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 1:20311 CHARTWELL CENTER DRIVE
Mailing Address - Street 2:P.O. BOX 2012
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031
Mailing Address - Country:US
Mailing Address - Phone:413-335-5343
Mailing Address - Fax:704-459-5074
Practice Address - Street 1:17720 LARGO PLACE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031
Practice Address - Country:US
Practice Address - Phone:413-335-5343
Practice Address - Fax:704-459-5074
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9238225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist