Provider Demographics
NPI:1477195055
Name:WENZE, IRA H III (MS, OTR/L)
Entity Type:Individual
Prefix:MR
First Name:IRA
Middle Name:H
Last Name:WENZE
Suffix:III
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 N NAVY BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-2001
Mailing Address - Country:US
Mailing Address - Phone:847-477-2789
Mailing Address - Fax:
Practice Address - Street 1:41 N NAVY BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-2001
Practice Address - Country:US
Practice Address - Phone:850-525-5870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17525225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty