Provider Demographics
NPI:1144942954
Name:JONES, WENDY SYLVIA (LMT)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:SYLVIA
Last Name:JONES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19307 E 126TH ST N
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-6227
Mailing Address - Country:US
Mailing Address - Phone:918-636-3807
Mailing Address - Fax:
Practice Address - Street 1:1501 N FLORENCE AVE STE 191
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3187
Practice Address - Country:US
Practice Address - Phone:918-283-4078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK163193225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist