Provider Demographics
NPI:1801234646
Name:WENGERD, DANIEL SCOTT (OTR/L)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:SCOTT
Last Name:WENGERD
Suffix:
Gender:M
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 1:8619 N 430 RD
Mailing Address - Street 2:
Mailing Address - City:ADAIR
Mailing Address - State:OK
Mailing Address - Zip Code:74330-2706
Mailing Address - Country:US
Mailing Address - Phone:918-864-0378
Mailing Address - Fax:
Practice Address - Street 1:8619 N 430 RD
Practice Address - Street 2:
Practice Address - City:ADAIR
Practice Address - State:OK
Practice Address - Zip Code:74330-2706
Practice Address - Country:US
Practice Address - Phone:918-864-0378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOT870225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist