Wendy Blake
Individual provider Active NPI Pediatric Occupational Therapist · Mexico, NY
NPI 1255720744 · NPPES record last updated Jan 21, 2015
Key facts
- NPI
- 1255720744
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Occupational Therapist 225XP0200X
- License
- 019414 (NY)
- Practice address
- 216 County Route 64
Mexico, NY 13114-3229 - Phone
- (315) 963-0864
- NPI assigned
- Jan 21, 2015
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019414 | NY | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 019414 | NY | Yes |
Addresses
Primary practice location
216 County Route 64
Mexico, NY 13114-3229
Mailing address
19472 US Route 11
Watertown, NY 13601-5387
Phone (315) 963-0864
Other providers in Mexico, NY
- Amy Jo Battles
- Amanda T Beattie
- Heather Bell
- Samantha Marie Bentley
- Holly Ann Besaw
- Julie Bond
- Kathleen Bosco
- Jessie Bradley
- Allison Marie Bratek
- Adrienne Larie Brimmer
All providers in Mexico, NY · Pediatric Occupational Therapist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.