Provider Demographics
NPI:1962709360
Name:ETTLES, WENDY C (OTD, MS, OTR/L)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:C
Last Name:ETTLES
Suffix:
Gender:F
Credentials:OTD, MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 TIOGA TRL
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-4420
Mailing Address - Country:US
Mailing Address - Phone:720-252-8698
Mailing Address - Fax:
Practice Address - Street 1:835 TIOGA TRL
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-4420
Practice Address - Country:US
Practice Address - Phone:720-252-8698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X, 225X00000X
COOT.0003138225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist