Individual
MS. CARLY GAIL WAGONSCHUTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2530 MARFITT RD, EAST LANSING, MI 48823-6343
(866) 486-8811
Mailing address
1217 SCHAVEY RD, DEWITT, MI 48820-9523
(517) 749-5320
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202008251
MI
Other
Enumeration date
05/24/2017
Last updated
05/24/2017
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