Provider Demographics
NPI:1336481639
Name:PHILLIPS, WENDY H (MS, OTR/C)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:H
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS, OTR/C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 VAN HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-4342
Mailing Address - Country:US
Mailing Address - Phone:704-883-9700
Mailing Address - Fax:704-872-9362
Practice Address - Street 1:2001 VAN HAVEN DRIVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-6208
Practice Address - Country:US
Practice Address - Phone:704-883-9700
Practice Address - Fax:704-872-9362
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC314000000X314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility