Provider Demographics
NPI:1376247239
Name:WENDT, MAKENNA (MOT)
Entity type:Individual
Prefix:
First Name:MAKENNA
Middle Name:
Last Name:WENDT
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:MAKENNA
Other - Middle Name:
Other - Last Name:KEES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2912 S BUSINESS DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-6520
Practice Address - Country:US
Practice Address - Phone:920-803-2179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist