Provider Demographics
NPI:1154949774
Name:TROUSDALE, WENDY DAWN (OTR)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:DAWN
Last Name:TROUSDALE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 835
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-0835
Mailing Address - Country:US
Mailing Address - Phone:830-997-1357
Mailing Address - Fax:830-997-1357
Practice Address - Street 1:402 W WINDCREST ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4465
Practice Address - Country:US
Practice Address - Phone:830-997-1357
Practice Address - Fax:830-990-6163
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106624225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist