Provider Demographics
NPI:1801063821
Name:PAYNE, WENDY LEE (OTR/L)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:LEE
Last Name:PAYNE
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 1:586 HOLLY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ALTAVISTA
Mailing Address - State:VA
Mailing Address - Zip Code:24517-2126
Mailing Address - Country:US
Mailing Address - Phone:434-369-1820
Mailing Address - Fax:
Practice Address - Street 1:586 HOLLY HILLS DR
Practice Address - Street 2:
Practice Address - City:ALTAVISTA
Practice Address - State:VA
Practice Address - Zip Code:24517-2126
Practice Address - Country:US
Practice Address - Phone:434-369-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003805225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist