Provider Demographics
NPI:1962630517
Name:FLINT, WENDY DONNA (COTA)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:DONNA
Last Name:FLINT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:DONNA
Other - Last Name:AIKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:5116 OLD BARN RD
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041-8940
Mailing Address - Country:US
Mailing Address - Phone:315-382-8939
Mailing Address - Fax:888-817-4702
Practice Address - Street 1:5116 OLD BARN RD
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:NY
Practice Address - Zip Code:13041-8940
Practice Address - Country:US
Practice Address - Phone:315-382-8939
Practice Address - Fax:888-817-4702
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005139-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant