Provider Demographics
NPI:1700072915
Name:HEALY, WENDY LEA (MOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:LEA
Last Name:HEALY
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:MISS
Other - First Name:WENDY
Other - Middle Name:LEA
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:1689 EAGLE HARBOR PKWY
Mailing Address - Street 2:STE D
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4802
Mailing Address - Country:US
Mailing Address - Phone:904-637-0148
Mailing Address - Fax:
Practice Address - Street 1:1689 EAGLE HARBOR PKWY
Practice Address - Street 2:STE D
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-4802
Practice Address - Country:US
Practice Address - Phone:904-637-0148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 9668225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist