Provider Demographics
NPI:1154062644
Name:THAMM, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:THAMM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 HUBBARD STREET
Mailing Address - Street 2:
Mailing Address - City:YOSAKUM
Mailing Address - State:TX
Mailing Address - Zip Code:77995
Mailing Address - Country:US
Mailing Address - Phone:361-293-2854
Mailing Address - Fax:361-293-6826
Practice Address - Street 1:402 HUBBARD STREET
Practice Address - Street 2:
Practice Address - City:YOSAKUM
Practice Address - State:TX
Practice Address - Zip Code:77995
Practice Address - Country:US
Practice Address - Phone:361-293-2854
Practice Address - Fax:361-293-6826
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206670224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant