Individual
STEPHANIE WAGGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6900 WEST COUNTRY CLUB DR, HUNTINGTON, WV 25705
(304) 733-1060
Mailing address
574 WILD CHERRY CIR, RACELAND, KY 41169-1177
(606) 836-5680
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
C1432
WV
Other
Enumeration date
12/06/2006
Last updated
07/08/2007
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