Provider Demographics
NPI:1962483941
Name:WRIGHT, WENDELL (OT)
Entity Type:Individual
Prefix:
First Name:WENDELL
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CLINT HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-6768
Mailing Address - Country:US
Mailing Address - Phone:270-442-9461
Mailing Address - Fax:
Practice Address - Street 1:100 CLINT HILL BLVD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-6771
Practice Address - Country:US
Practice Address - Phone:270-442-9461
Practice Address - Fax:270-441-0079
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR-1403225XH1200X
KY225XH1200X
KY135492225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000203977OtherANTHEM
KY0877260002OtherCIGNA
KY5004906Medicare PIN
KY670001213Medicare PIN
KYK099760Medicare PIN
KY000000203977OtherANTHEM
KYS70319Medicare UPIN
KY0567801Medicare PIN