Provider Demographics
NPI:1568815165
Name:WENDT, ALYSSA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:
Last Name:WENDT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6973 E CANAL RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-7967
Mailing Address - Country:US
Mailing Address - Phone:716-909-0938
Mailing Address - Fax:
Practice Address - Street 1:6973 E CANAL RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-7967
Practice Address - Country:US
Practice Address - Phone:716-909-0938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020744225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist