Individual
MELANIE LEANNE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT
Contact information
Practice address
872 COLLEGE BLVD # 8408, OSAGE BEACH, MO 65065-8408
(573) 302-0900
Mailing address
13299 REDBARN RD, CAMERON, OK 74932-2602
(918) 839-4575
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119009765
VA
225X00000X
Occupational Therapist
2022022632
MO
Other
Enumeration date
06/18/2022
Last updated
01/09/2023
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