Provider Demographics
NPI:1134565781
Name:TRENT, WRENDA JO
Entity type:Individual
Prefix:MRS
First Name:WRENDA
Middle Name:JO
Last Name:TRENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4345 WORTHINGTON LN
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-9226
Mailing Address - Country:US
Mailing Address - Phone:434-258-5179
Mailing Address - Fax:434-821-3719
Practice Address - Street 1:4345 WORTHINGTON LN
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-9226
Practice Address - Country:US
Practice Address - Phone:434-258-5179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002872225X00000X, 225XP0019X
NC7400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation