NPIMap

Wendi Lagore, COTA/L

Individual provider Active NPI Occupational Therapy Assistant · Green Forest, AR

NPI 1902221187 · NPPES record last updated Feb 25, 2014

Key facts

NPI
1902221187
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
2013033612 (MO)
Practice address
805 Tommy Ratzlaff Ave
Green Forest, AR 72638-2911
Phone
(870) 438-5201
Fax
(870) 438-6214
NPI assigned
Feb 25, 2014
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
2013033612MOMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Green Forest Schools Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 2013033612 MO Yes

Addresses

Primary practice location

805 Tommy Ratzlaff Ave
Green Forest, AR 72638-2911

Mailing address

PO Box 1950
Green Forest, AR 72638-1950
Phone (870) 438-5201

Other names

  • Mrs. Wendi Young Former name

Other providers in Green Forest, AR

All providers in Green Forest, AR · Occupational Therapy Assistant in Arkansas

Sources for this page

Verify at the official NPI Registry.