Provider Demographics
NPI:1538257027
Name:WENTWORTH, PAULETT R (CERTIFIED FITTER)
Entity type:Individual
Prefix:
First Name:PAULETT
Middle Name:R
Last Name:WENTWORTH
Suffix:
Gender:F
Credentials:CERTIFIED FITTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4419 CENTENNIAL #106
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907
Mailing Address - Country:US
Mailing Address - Phone:719-351-8286
Mailing Address - Fax:719-265-9334
Practice Address - Street 1:4419 CENTENNIAL BLVD # 106
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3739
Practice Address - Country:US
Practice Address - Phone:719-351-8286
Practice Address - Fax:719-265-9334
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter