Provider Demographics
NPI:1235663618
Name:STEWART, WENDI
Entity Type:Individual
Prefix:MS
First Name:WENDI
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:WENIFRED
Other - Middle Name:SHANNON
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:8605 EDGEBROOK TER
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76116-7666
Mailing Address - Country:US
Mailing Address - Phone:817-560-2195
Mailing Address - Fax:
Practice Address - Street 1:8605 EDGEBROOK TER
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76116-7666
Practice Address - Country:US
Practice Address - Phone:817-560-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207032224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant