Provider Demographics
NPI:1609601194
Name:WENGYN, MADELYN ELIZABETH (OTD)
Entity type:Individual
Prefix:DR
First Name:MADELYN
Middle Name:ELIZABETH
Last Name:WENGYN
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2609 DURANT WOODS ST
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-5935
Mailing Address - Country:US
Mailing Address - Phone:813-507-0866
Mailing Address - Fax:
Practice Address - Street 1:4725 US HIGHWAY 98 S STE 101102
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-4334
Practice Address - Country:US
Practice Address - Phone:863-328-5410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT25646224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant