Provider Demographics
NPI:1275707457
Name:BRANDT, WENDY LYNNE (COTA)
Entity Type:Individual
Prefix:MISS
First Name:WENDY
Middle Name:LYNNE
Last Name:BRANDT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17250 KNOLL TRAIL DR APT 2002
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1162
Mailing Address - Country:US
Mailing Address - Phone:214-850-9321
Mailing Address - Fax:
Practice Address - Street 1:3498 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:RESCUE
Practice Address - State:CA
Practice Address - Zip Code:95672-9625
Practice Address - Country:US
Practice Address - Phone:530-391-8670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00354224Z00000X
CA14618225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant