Provider Demographics
NPI:1235480690
Name:WENZL, LISA RENAE (OTD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RENAE
Last Name:WENZL
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64107 733 RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NE
Mailing Address - Zip Code:68305-8522
Mailing Address - Country:US
Mailing Address - Phone:402-540-3410
Mailing Address - Fax:
Practice Address - Street 1:1322 U ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NE
Practice Address - Zip Code:68305-3215
Practice Address - Country:US
Practice Address - Phone:402-274-6164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1272225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist