Provider Demographics
NPI:1245434018
Name:HEADEN, WENDY RENE (OTR)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:RENE
Last Name:HEADEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 VICTORY LN
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-8405
Mailing Address - Country:US
Mailing Address - Phone:972-567-1263
Mailing Address - Fax:
Practice Address - Street 1:246 VICTORY LN
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-8405
Practice Address - Country:US
Practice Address - Phone:972-567-1263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107503225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist