Individual
DR. SHANNON ROSE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Contact information
Practice address
27501 SW 95TH AVE STE 960, WILSONVILLE, OR 97070-7713
(503) 657-8903
(503) 266-8632
Mailing address
610 HIGH ST, OREGON CITY, OR 97045-2241
(503) 657-8903
(503) 266-8632
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
350329
OR
225XE0001X
Environmental Modification Occupational Therapist
350329
OR
225XM0800X
Mental Health Occupational Therapist
350329
OR
Other
Enumeration date
10/06/2021
Last updated
02/19/2026
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