Individual
ALISSA MARIE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOTR/L
Contact information
Practice address
3360 GATEWAY RD, BROOKFIELD, WI 53045-5115
(414) 964-4777
(414) 964-4778
Mailing address
608 LAUREL LAKE RD APT 7, THIENSVILLE, WI 53092-1240
(920) 629-4338
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
8163-26
WI
Other
Enumeration date
02/28/2023
Last updated
02/28/2023
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