Provider Demographics
NPI:1972761955
Name:WANNER, WENDI
Entity type:Individual
Prefix:MRS
First Name:WENDI
Middle Name:
Last Name:WANNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13310
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389-3310
Mailing Address - Country:US
Mailing Address - Phone:661-873-7975
Mailing Address - Fax:661-377-0295
Practice Address - Street 1:4101 EASTON DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-1021
Practice Address - Country:US
Practice Address - Phone:661-377-1700
Practice Address - Fax:661-377-1707
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2328225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA133052274OtherBLUE CROSS OF CA
CA193518600OtherUS DEPT OF LABOR
CADA4626OtherRAILROAD MEDICARE
CADE5473OtherRAILROAD MEDICARE
CAOT023280Medicaid
CA193518600OtherUS DEPT OF LABOR