Provider Demographics
NPI:1609692110
Name:PHILLIPS, WENDY APRIL (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:APRIL
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:APRIL
Other - Last Name:DE FOREST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:260 W BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-2126
Mailing Address - Country:US
Mailing Address - Phone:415-342-8697
Mailing Address - Fax:
Practice Address - Street 1:18 COMMERCIAL BLVD STE 6
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-6120
Practice Address - Country:US
Practice Address - Phone:415-320-1329
Practice Address - Fax:415-729-1780
Is Sole Proprietor?:No
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4210225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics