Provider Demographics
NPI:1215609326
Name:YOUNG, WENDY (OTR)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:HATFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75-165 HUALALAI RD
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-3722
Mailing Address - Country:US
Mailing Address - Phone:808-329-0591
Mailing Address - Fax:808-329-2066
Practice Address - Street 1:75-165 HUALALAI RD.
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1714
Practice Address - Country:US
Practice Address - Phone:808-329-0591
Practice Address - Fax:808-329-2066
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOT2156225X00000X
HIOT-2156225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist