Provider Demographics
NPI:1588857981
Name:MOORE, WENDY HEATHER (OT)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:HEATHER
Last Name:MOORE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:STEINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:540 S ANDREASEN DR
Mailing Address - Street 2:STE C
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-1916
Mailing Address - Country:US
Mailing Address - Phone:760-591-7750
Mailing Address - Fax:760-294-9813
Practice Address - Street 1:9909 MIRA MESA BLVD
Practice Address - Street 2:STE 120
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1056
Practice Address - Country:US
Practice Address - Phone:858-693-0436
Practice Address - Fax:858-693-0437
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 6668225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOT6668AMedicare PIN
CABG470ZMedicare PIN