Provider Demographics
NPI:1790062602
Name:WAYNICK, KATHERINE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:WAYNICK
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 1:5149 KING RUSTY LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4628
Mailing Address - Country:US
Mailing Address - Phone:704-408-5048
Mailing Address - Fax:
Practice Address - Street 1:5149 KING RUSTY LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4628
Practice Address - Country:US
Practice Address - Phone:704-408-5048
Practice Address - Fax:336-923-5357
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-05
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8104225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist