Provider Demographics
NPI:1962689216
Name:BATH, WENDALYN WEAVER (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:WENDALYN
Middle Name:WEAVER
Last Name:BATH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 WIGMORE CT
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-3164
Mailing Address - Country:US
Mailing Address - Phone:912-897-3086
Mailing Address - Fax:
Practice Address - Street 1:112 WIGMORE CT
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-3164
Practice Address - Country:US
Practice Address - Phone:912-897-3086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000787225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics