Provider Demographics
NPI:1881849560
Name:OTT, WENDY YVONNE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:YVONNE
Last Name:OTT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ROSEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-7912
Mailing Address - Country:US
Mailing Address - Phone:607-765-1586
Mailing Address - Fax:
Practice Address - Street 1:24 ROSEWOOD RD
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-7912
Practice Address - Country:US
Practice Address - Phone:607-765-1586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-23
Last Update Date:2008-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009265-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist