Provider Demographics
NPI:1669723110
Name:AYDINYAN, WENDY KATE (OTR/L)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:KATE
Last Name:AYDINYAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 W H ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-2354
Mailing Address - Country:US
Mailing Address - Phone:802-578-6546
Mailing Address - Fax:
Practice Address - Street 1:2001 W H ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-2354
Practice Address - Country:US
Practice Address - Phone:802-578-6546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2013-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072.0088261225X00000X
OK1841225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist