Provider Demographics
NPI:1962695742
Name:BEACH, WENDY SUE (COTA)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:SUE
Last Name:BEACH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16450 LONE PINE RD
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96022-8531
Mailing Address - Country:US
Mailing Address - Phone:530-646-7551
Mailing Address - Fax:
Practice Address - Street 1:160 S PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2006
Practice Address - Country:US
Practice Address - Phone:805-964-4871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA634224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant