Individual
MS. CAROLE SUE WAGNER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
O.T.R./L
Contact information
Practice address
1 JEFFERSON BARRACKS DR, SAINT LOUIS, MO 63125-4181
(314) 894-6505
(314) 845-5077
Mailing address
862 PHEASANT WOODS DR, MANCHESTER, MO 63021-4300
(636) 394-7429
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2004012994
MO
Other
Enumeration date
05/10/2006
Last updated
07/08/2007
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