Provider Demographics
NPI:1205124666
Name:WENDEL, LEAH (OTR/L)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:WENDEL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:WISNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3307 MONTEREY RD
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-8335
Mailing Address - Country:US
Mailing Address - Phone:607-434-9380
Mailing Address - Fax:
Practice Address - Street 1:11757 KATY FWY
Practice Address - Street 2:KIRKWOOD ATRIUM III
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1733
Practice Address - Country:US
Practice Address - Phone:281-668-0644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114907225X00000X
CA14413225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7302344Medicaid