Individual
ANDREW WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
24076 SE STARK ST STE 200, GRESHAM, OR 97030-3376
(503) 674-7860
Mailing address
24076 SE STARK ST STE 200, GRESHAM, OR 97030-3376
(503) 674-7860
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
OR
225XH1200X
Hand Occupational Therapist
Primary
423249
OR
Other
Enumeration date
04/23/2015
Last updated
11/29/2022
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