Provider Demographics
NPI:1245393172
Name:WENZL, TAMARA BENNETT (MED)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:BENNETT
Last Name:WENZL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:BENNETT
Other - Last Name:WENZL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:516 WOODBERRY DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2862
Mailing Address - Country:US
Mailing Address - Phone:704-606-6885
Mailing Address - Fax:
Practice Address - Street 1:516 WOODBERRY DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2862
Practice Address - Country:US
Practice Address - Phone:704-606-6885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No174400000XOther Service ProvidersSpecialist