Provider Demographics
NPI:1366840704
Name:COLLINS, WENDY (OTA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 NE LOOP 820
Mailing Address - Street 2:BUSINESS TOWER 1 SUITE 200
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-7209
Mailing Address - Country:US
Mailing Address - Phone:817-292-8787
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:12941 NORTH FWY
Practice Address - Street 2:STE. 401
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-1240
Practice Address - Country:US
Practice Address - Phone:832-253-1188
Practice Address - Fax:832-253-1181
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208127224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant