Basic Information
| Provider Information | |||||||||
| NPI: | 1437363785 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLAYTON | ||||||||
| FirstName: | WENDY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 JACKSON AVE | ||||||||
| Address2: | |||||||||
| City: | PETAL | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394652330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012504815 | ||||||||
| FaxNumber: | 6012506859 | ||||||||
| Practice Location | |||||||||
| Address1: | 206 MARYLAND AVE | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396483926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012504815 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | TA1530 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.