Provider Demographics
NPI:1710699418
Name:ENFIELD, WENDY KATHLEEN (COTA/L)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:KATHLEEN
Last Name:ENFIELD
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 1:408 W 1080 N
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-5180
Mailing Address - Country:US
Mailing Address - Phone:801-319-9144
Mailing Address - Fax:
Practice Address - Street 1:867 S 800 W
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-4505
Practice Address - Country:US
Practice Address - Phone:801-785-9019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9439290-4202224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant