Provider Demographics
NPI:1790175586
Name:TRAVERSE, WENDY (OT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:TRAVERSE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 LEDGE ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3073
Mailing Address - Country:US
Mailing Address - Phone:603-966-1000
Mailing Address - Fax:
Practice Address - Street 1:141 LEDGE ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3073
Practice Address - Country:US
Practice Address - Phone:603-966-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-31
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8379225X00000X
NH3881225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist