Provider Demographics
NPI:1801377692
Name:WENTZ, ERIN ALICE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:ALICE
Last Name:WENTZ
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 1:5712 CRUTCHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-9700
Mailing Address - Country:US
Mailing Address - Phone:828-514-9825
Mailing Address - Fax:
Practice Address - Street 1:2610 TOSCA TRL
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-9654
Practice Address - Country:US
Practice Address - Phone:919-448-6018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9453225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist