Provider Demographics
NPI:1952831992
Name:JONES, WENDI RAYLENE WINGATE (OTR/L MA)
Entity Type:Individual
Prefix:
First Name:WENDI
Middle Name:RAYLENE WINGATE
Last Name:JONES
Suffix:
Gender:F
Credentials:OTR/L MA
Other - Prefix:
Other - First Name:WENDI
Other - Middle Name:RAYLENE
Other - Last Name:WINGATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:429 20TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-1687
Mailing Address - Country:US
Mailing Address - Phone:218-969-1313
Mailing Address - Fax:
Practice Address - Street 1:142 1ST ST N
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1273
Practice Address - Country:US
Practice Address - Phone:320-257-4931
Practice Address - Fax:320-253-1170
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104328225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist