Individual
MR. PAUL MARTIN BAGNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
4920 WOODMAR DR SW, ROANOKE, VA 24018-1651
(540) 400-0897
Mailing address
3303 CIRCLE BROOK DR APT L, ROANOKE, VA 24018-8214
(703) 853-4584
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131-001616
VA
Other
Enumeration date
07/12/2016
Last updated
07/12/2016
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