Provider Demographics
NPI:1306142385
Name:HIATT, WENDY SUE (MSOT)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:SUE
Last Name:HIATT
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1647 MALLORY LANE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BRENTWOOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-661-5437
Mailing Address - Fax:
Practice Address - Street 1:1647 MALLORY LANE
Practice Address - Street 2:SUITE 103
Practice Address - City:BRENTWOOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-661-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT4259225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist