Individual
NICHOLAS WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
358 LAGOON LANE, SILVERTHORNE, CO 80498
(218) 443-3560
Mailing address
358 LAGOON LANE, SILVERTHORNE, CO 80498
(218) 443-3560
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
346355
OR
Other
Enumeration date
12/17/2019
Last updated
12/17/2019
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