Provider Demographics
NPI:1518572684
Name:RAGER, WENDY LEE (COTA/L)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LEE
Last Name:RAGER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BAIRD ST
Mailing Address - Street 2:
Mailing Address - City:HARVEYS LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:18618-2250
Mailing Address - Country:US
Mailing Address - Phone:570-406-0223
Mailing Address - Fax:
Practice Address - Street 1:110 BAIRD ST
Practice Address - Street 2:
Practice Address - City:HARVEYS LAKE
Practice Address - State:PA
Practice Address - Zip Code:18618-2250
Practice Address - Country:US
Practice Address - Phone:570-406-0223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP002049L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant