Provider Demographics
NPI:1134217268
Name:SIT, WENDY MARIE SOBERG (OTRL)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:MARIE SOBERG
Last Name:SIT
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MISS
Other - First Name:WENDY
Other - Middle Name:MARIE SOBERG
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:4740 CROOKED LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8812
Mailing Address - Country:US
Mailing Address - Phone:617-308-7987
Mailing Address - Fax:
Practice Address - Street 1:36975 5 MILE RD
Practice Address - Street 2:MARYWOOD NURSING CARE CENTER
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1871
Practice Address - Country:US
Practice Address - Phone:734-464-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007566225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist