Individual
KANDY KAY WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.T.
Contact information
Practice address
21526 HARPER AVE, ST. CLAIR SHORES, MI 48080
(586) 242-5729
Mailing address
38815 LAKESHORE DRIVE, HARRISON TOWNSHIP, MI 48045
(586) 242-5729
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
332924-00
MI
Other
Enumeration date
06/08/2010
Last updated
06/08/2010
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