Provider Demographics
NPI:1255876322
Name:WENTWORTH, PATTY (M ED, MA)
Entity type:Individual
Prefix:
First Name:PATTY
Middle Name:
Last Name:WENTWORTH
Suffix:
Gender:F
Credentials:M ED, MA
Other - Prefix:
Other - First Name:PATTY
Other - Middle Name:
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, MA
Mailing Address - Street 1:98 ORCHARD ST
Mailing Address - Street 2:2
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-3130
Mailing Address - Country:US
Mailing Address - Phone:978-660-3770
Mailing Address - Fax:
Practice Address - Street 1:321 FORTUNE BLVD
Practice Address - Street 2:2
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1750
Practice Address - Country:US
Practice Address - Phone:508-478-0207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist