Individual
MRS. TERESA CHRISTINA WAGGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
201 S NORTHPARK LN, JOPLIN, MO 64801-8426
(417) 623-4313
(417) 621-0129
Mailing address
201 S NORTHPARK LN, JOPLIN, MO 64801-8426
(417) 623-4313
(417) 621-0129
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2010019101
MO
Other
Enumeration date
08/27/2010
Last updated
08/27/2010
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