Provider Demographics
NPI:1346518628
Name:WATSON, WENDY (LAT, ATC, LMT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:LAT, ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 SW MULVANE ST
Mailing Address - Street 2:APT 1
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1412
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1295 SW MULVANE ST
Practice Address - Street 2:APT 1
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1412
Practice Address - Country:US
Practice Address - Phone:785-383-8837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-00788225400000X, 2255A2300X
TX36927225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist