Provider Demographics
NPI:1427684588
Name:MOTEN, WENONA RENEE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:WENONA
Middle Name:RENEE
Last Name:MOTEN
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11036 OUTPOST DR
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-4808
Mailing Address - Country:US
Mailing Address - Phone:301-346-1720
Mailing Address - Fax:
Practice Address - Street 1:6831 WISCONSIN AVE # 401
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20815-6122
Practice Address - Country:US
Practice Address - Phone:301-346-1720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR016392083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports MedicineGroup - Single Specialty