Provider Demographics
NPI:1417106337
Name:STEVENS, WANDA LYNNE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:LYNNE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:WANDA
Other - Middle Name:LYNNE
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 MEDIA LINE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-4602
Mailing Address - Country:US
Mailing Address - Phone:610-356-7353
Mailing Address - Fax:610-355-7649
Practice Address - Street 1:100 MEDIA LINE RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4602
Practice Address - Country:US
Practice Address - Phone:610-356-7353
Practice Address - Fax:610-355-7649
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010046225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist