Individual
MICHAEL CHARLES WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
170 2ND ST S, NAMPA, ID 83651-3708
(208) 385-3651
Mailing address
170 2ND ST S, NAMPA, ID 83651-3708
(208) 385-3651
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-1598
ID
Other
Enumeration date
05/10/2016
Last updated
05/10/2016
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