Provider Demographics
NPI:1992993505
Name:HARTSON, WENDY
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:HARTSON
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 1:21 SPURS LN
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1669
Mailing Address - Country:US
Mailing Address - Phone:210-478-5211
Mailing Address - Fax:210-558-4664
Practice Address - Street 1:21 SPURS LN
Practice Address - Street 2:SUITE 310
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1669
Practice Address - Country:US
Practice Address - Phone:210-478-5211
Practice Address - Fax:210-558-4664
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109661225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4228582Medicare PIN
OH4228581Medicare PIN