Provider Demographics
NPI:1912103334
Name:CARD, WENDY SUE (OTR-L)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:SUE
Last Name:CARD
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 1:371 HALSEY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BARTON
Mailing Address - State:NY
Mailing Address - Zip Code:13734-1512
Mailing Address - Country:US
Mailing Address - Phone:607-759-7867
Mailing Address - Fax:
Practice Address - Street 1:87 ELLIS CREEK RD
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NY
Practice Address - Zip Code:14892-9540
Practice Address - Country:US
Practice Address - Phone:607-972-5158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011909-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist