Provider Demographics
NPI:1467654087
Name:KATHOL, WENDY L (COTA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:L
Last Name:KATHOL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7402 S 189TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-1274
Mailing Address - Country:US
Mailing Address - Phone:402-614-1647
Mailing Address - Fax:
Practice Address - Street 1:4405 NORMAL BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5551
Practice Address - Country:US
Practice Address - Phone:402-484-4512
Practice Address - Fax:402-488-2779
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE236224Z00000X
IA733224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant