Individual
MRS. JANET WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16 OLD COUNTY RD 128, JEFFERSONVILLE, NY 12748
(845) 807-1132
Mailing address
PO BOX 412, JEFFERSONVILLE, NY 12748-0412
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
006077-1
NY
Other
Enumeration date
09/25/2009
Last updated
08/24/2013
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