Provider Demographics
NPI:1528272002
Name:WENSLEY, ROBERT E (ORTHOTIST)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:WENSLEY
Suffix:
Gender:M
Credentials:ORTHOTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 WESTGATE CENTER CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2936
Mailing Address - Country:US
Mailing Address - Phone:336-725-4555
Mailing Address - Fax:336-725-4556
Practice Address - Street 1:3641 WESTGATE CENTER CIR
Practice Address - Street 2:SUITE B
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2936
Practice Address - Country:US
Practice Address - Phone:336-725-4555
Practice Address - Fax:336-725-4556
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC22358174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703050Medicaid
NC7795205Medicaid
NC7795205Medicaid