Provider Demographics
NPI:1215272414
Name:WENDEL, DEVIN
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:
Last Name:WENDEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VERGENNES
Mailing Address - State:VT
Mailing Address - Zip Code:05491-1035
Mailing Address - Country:US
Mailing Address - Phone:802-877-6991
Mailing Address - Fax:802-877-6993
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:
Practice Address - City:VERGENNES
Practice Address - State:VT
Practice Address - Zip Code:05491-1035
Practice Address - Country:US
Practice Address - Phone:802-877-6991
Practice Address - Fax:802-877-6993
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT10400780042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer