Provider Demographics
NPI:1275887291
Name:BUCHHOLZ, WENDA LYNNE
Entity Type:Individual
Prefix:
First Name:WENDA
Middle Name:LYNNE
Last Name:BUCHHOLZ
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 1:1820 HILLCREST DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-3636
Mailing Address - Country:US
Mailing Address - Phone:402-682-4808
Mailing Address - Fax:402-682-6563
Practice Address - Street 1:1820 HILLCREST DR
Practice Address - Street 2:SUITE A
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3636
Practice Address - Country:US
Practice Address - Phone:402-682-4808
Practice Address - Fax:402-682-6563
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE592225X00000X
IA993225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist