Provider Demographics
NPI:1457555880
Name:SCHMIDT, WENDY MARY (OT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:MARY
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1015
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-6015
Mailing Address - Country:US
Mailing Address - Phone:978-518-0264
Mailing Address - Fax:
Practice Address - Street 1:14 ORANGE ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2806
Practice Address - Country:US
Practice Address - Phone:978-518-0264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAH 6997 OT174400000X
OHOT-0347174400000X
VA0119-003726174400000X
990333174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA426338OtherTUFTS HEALTH PLAN