Provider Demographics
NPI:1376798439
Name:MENDEZ, WANDA C (MS OTR L)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:C
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:MS OTR L
Other - Prefix:MRS
Other - First Name:WANDA
Other - Middle Name:C
Other - Last Name:MENDEZ-PATURNO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS OTR L
Mailing Address - Street 1:9728 3RD AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7203
Mailing Address - Country:US
Mailing Address - Phone:917-693-7454
Mailing Address - Fax:
Practice Address - Street 1:9728 3RD AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7203
Practice Address - Country:US
Practice Address - Phone:917-693-7454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009658-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics