Individual
MINDY WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
401 CRYSTAL PL, SEAL BEACH, CA 90740-6219
(562) 310-9257
Mailing address
401 CRYSTAL PL, SEAL BEACH, CA 90740-6219
(562) 310-9257
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
9000
CA
Other
Enumeration date
01/15/2014
Last updated
01/15/2014
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