Provider Demographics
NPI:1699053462
Name:AZZARELLA, WENDY (COTA/L)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:AZZARELLA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 BILLY HOWEY RD
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-8166
Mailing Address - Country:US
Mailing Address - Phone:704-728-1535
Mailing Address - Fax:
Practice Address - Street 1:2101 BILLY HOWEY RD
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-8166
Practice Address - Country:US
Practice Address - Phone:704-728-1535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4939224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant