Provider Demographics
NPI:1831282169
Name:JENNINGS, WENDY M (OTR)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:M
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10205 LAUREN PASS
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9328
Mailing Address - Country:US
Mailing Address - Phone:317-435-2774
Mailing Address - Fax:317-596-6244
Practice Address - Street 1:10205 LAUREN PASS
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9328
Practice Address - Country:US
Practice Address - Phone:317-435-2774
Practice Address - Fax:317-596-6244
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000885A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist