Individual
MICHAEL SCOTT WADSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
622 S 57TH PL, SPRINGFIELD, OR 97478-5487
(541) 726-8076
Mailing address
622 S 57TH PL, SPRINGFIELD, OR 97478-5487
(541) 726-8076
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
—
—
Other
Enumeration date
10/10/2006
Last updated
07/08/2007
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