Provider Demographics
NPI:1063548220
Name:KIRBY, WENDY M (LATC)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:M
Last Name:KIRBY
Suffix:
Gender:F
Credentials:LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-4807
Mailing Address - Country:US
Mailing Address - Phone:508-999-8731
Mailing Address - Fax:
Practice Address - Street 1:285 OLD WESTPORT RD
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-2356
Practice Address - Country:US
Practice Address - Phone:508-999-8731
Practice Address - Fax:508-999-8867
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer