Provider Demographics
NPI:1295100634
Name:GUTIERREZ, WENDY MICHELLE (ATC)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:MICHELLE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4434 EXODUS DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-4048
Mailing Address - Country:US
Mailing Address - Phone:956-489-1954
Mailing Address - Fax:
Practice Address - Street 1:363 RICHLAND AVE
Practice Address - Street 2:259
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-3210
Practice Address - Country:US
Practice Address - Phone:956-508-4829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH004768390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program