Provider Demographics
NPI:1073815999
Name:EATON, WENDY D (CFTS)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:D
Last Name:EATON
Suffix:
Gender:F
Credentials:CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3603
Mailing Address - Country:US
Mailing Address - Phone:423-697-0057
Mailing Address - Fax:423-648-9366
Practice Address - Street 1:2150 N OCOEE ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3936
Practice Address - Country:US
Practice Address - Phone:423-559-0013
Practice Address - Fax:423-559-2442
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CFTS1106225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507472Medicaid
GA000973794EMedicaid
TN1455062Medicaid
GA000973794CMedicaid
GA000973794DMedicaid
1254770003Medicare NSC
1254770002Medicare NSC