Individual
MRS. BONNY MICHELLE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OYR / CHT
Contact information
Practice address
663 SUNSET LN, CULPEPER, VA 22701-3919
(540) 825-5368
(540) 829-0937
Mailing address
1503 WRIGHTS LN, RADIANT, VA 22732-3254
Taxonomy
Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
Primary
0119000341
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
294919
MAMSI
VA
01
—
334575
ANTHEM BCBS
VA
01
—
7727302
AETNA
VA
Enumeration date
09/01/2006
Last updated
07/08/2007
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