Provider Demographics
NPI:1174716435
Name:ELL, WENDY (OT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:ELL
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 1:222 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-2821
Mailing Address - Country:US
Mailing Address - Phone:573-581-3000
Mailing Address - Fax:573-581-0888
Practice Address - Street 1:222 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2821
Practice Address - Country:US
Practice Address - Phone:573-581-3000
Practice Address - Fax:573-581-0888
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist