Provider Demographics
NPI:1972980134
Name:VANOOYEN, WENDY C (OTR/L)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:C
Last Name:VANOOYEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:WENDELYN
Other - Middle Name:CLEMENTYN
Other - Last Name:WATERVAL-VANOOYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1145 11TH PL SW
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-7978
Mailing Address - Country:US
Mailing Address - Phone:425-292-9221
Mailing Address - Fax:
Practice Address - Street 1:1145 11TH PL SW
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-7978
Practice Address - Country:US
Practice Address - Phone:425-292-9221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 60532066208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation