Provider Demographics
NPI:1770759987
Name:COUNIHAN-NELSON, WENDY J (OTR/L)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:J
Last Name:COUNIHAN-NELSON
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 1:15 PURCHASE ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-1603
Mailing Address - Country:US
Mailing Address - Phone:508-579-4576
Mailing Address - Fax:
Practice Address - Street 1:111 HUNTOON HIGHWAY
Practice Address - Street 2:
Practice Address - City:ROCHDALE
Practice Address - State:MA
Practice Address - Zip Code:01542-1305
Practice Address - Country:US
Practice Address - Phone:508-579-4576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21030225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist