Provider Demographics
NPI:1326162694
Name:FORE, WENDY FUTRELL (COTA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:FUTRELL
Last Name:FORE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 CLIMBING IVY CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-2708
Mailing Address - Country:US
Mailing Address - Phone:919-818-6646
Mailing Address - Fax:
Practice Address - Street 1:300 MEADOWLAND DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-8502
Practice Address - Country:US
Practice Address - Phone:919-732-2258
Practice Address - Fax:919-732-2910
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2597224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant