Provider Demographics
NPI:1639472574
Name:WENTE, MELANIE (OT/L)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:WENTE
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 RADIO DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-8409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 RADIO DR
Practice Address - Street 2:SUITE 110
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-8409
Practice Address - Country:US
Practice Address - Phone:651-702-0555
Practice Address - Fax:651-702-5680
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101655225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist