Provider Demographics
NPI:1750389912
Name:BURNETT, WENDY R (OTR / CHT)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:R
Last Name:BURNETT
Suffix:
Gender:F
Credentials:OTR / CHT
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:R
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR CHT
Mailing Address - Street 1:219 E 69TH ST
Mailing Address - Street 2:STE 1K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5452
Mailing Address - Country:US
Mailing Address - Phone:212-472-1000
Mailing Address - Fax:212-472-1066
Practice Address - Street 1:219 E 69TH ST
Practice Address - Street 2:STE 1K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5452
Practice Address - Country:US
Practice Address - Phone:212-472-1000
Practice Address - Fax:212-472-1066
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001740-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q55261Medicare UPIN