Provider Demographics
NPI:1205172087
Name:WENDEROTH, CHELSEA RENEE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CHELSEA
Middle Name:RENEE
Last Name:WENDEROTH
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 1:2546 RUBY LN
Mailing Address - Street 2:
Mailing Address - City:WADESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47638-9709
Mailing Address - Country:US
Mailing Address - Phone:812-746-8517
Mailing Address - Fax:
Practice Address - Street 1:216 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-1548
Practice Address - Country:US
Practice Address - Phone:812-382-4644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-22
Last Update Date:2012-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009411225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist