Provider Demographics
NPI:1376675207
Name:KITKOSKI, WENDY (OTR, L)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:KITKOSKI
Suffix:
Gender:F
Credentials:OTR, L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GREENWOOD AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-4427
Mailing Address - Country:US
Mailing Address - Phone:501-625-7800
Mailing Address - Fax:501-325-2727
Practice Address - Street 1:100 GREENWOOD AVE
Practice Address - Street 2:SUITE D
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4427
Practice Address - Country:US
Practice Address - Phone:501-625-7800
Practice Address - Fax:501-325-2727
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1347225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162569721Medicaid