Provider Demographics
NPI:1285672097
Name:GROSSMAN, WENDY (OT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:689 TAMIAMI TRL N
Mailing Address - Street 2:SUITE E
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-8100
Mailing Address - Country:US
Mailing Address - Phone:239-261-0291
Mailing Address - Fax:239-261-0678
Practice Address - Street 1:12840 TAMIAMI TRL N
Practice Address - Street 2:SUITE 200
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1619
Practice Address - Country:US
Practice Address - Phone:239-592-5500
Practice Address - Fax:239-592-1614
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT6930225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist