Provider Demographics
NPI:1790042240
Name:GRIMMETT, WENDY JENKINS (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:JENKINS
Last Name:GRIMMETT
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 LAFAYETTE 23
Mailing Address - Street 2:
Mailing Address - City:BUCKNER
Mailing Address - State:AR
Mailing Address - Zip Code:71827-9514
Mailing Address - Country:US
Mailing Address - Phone:870-533-2073
Mailing Address - Fax:870-533-2073
Practice Address - Street 1:1315 WALNUT ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-4446
Practice Address - Country:US
Practice Address - Phone:903-794-2705
Practice Address - Fax:903-793-1203
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113278225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics