Provider Demographics
NPI:1649477704
Name:MEGUESS, WENDY L (OTR)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:L
Last Name:MEGUESS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:L
Other - Last Name:KOLBET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:12312 W ENGELMANN DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1416
Mailing Address - Country:US
Mailing Address - Phone:208-705-7438
Mailing Address - Fax:
Practice Address - Street 1:1351 W PINE AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5031
Practice Address - Country:US
Practice Address - Phone:208-895-6431
Practice Address - Fax:208-887-1204
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003557225X00000X
IDOT-1058225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist