Individual
JENNIFER L WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
120 MEADOW VIEW DR, JUSTIN, TX 76247-9639
(940) 648-2731
Mailing address
10711 JUSTIN CEMETERY RD LOT 264, JUSTIN, TX 76247-8032
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
212402
TX
Other
Enumeration date
01/29/2019
Last updated
01/29/2019
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