Individual
MRS. CAROLYN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1130 N WESTFIELD ST, OSHKOSH, WI 54902-3217
(920) 237-2163
Mailing address
1130 N WESTFIELD ST, OSHKOSH, WI 54902-3217
(920) 237-2163
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1176-19
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40460700
—
WI
Enumeration date
08/06/2008
Last updated
08/06/2008
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