Provider Demographics
NPI:1831472588
Name:STANFORD, WENDY WALKER (OTR)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:WALKER
Last Name:STANFORD
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 1:6226 HOPE ESTATE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70820-5068
Mailing Address - Country:US
Mailing Address - Phone:225-330-4438
Mailing Address - Fax:
Practice Address - Street 1:6226 HOPE ESTATE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70820-5068
Practice Address - Country:US
Practice Address - Phone:225-330-4438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11587225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist