Individual
WAYNE SCOTT WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 S CRAPO ST, MOUNT PLEASANT, MI 48858-2944
(989) 773-5918
(989) 772-0248
Mailing address
400 S CRAPO ST, MOUNT PLEASANT, MI 48858-2944
(989) 773-5918
(989) 772-0248
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202005126
MI
224Z00000X
Occupational Therapy Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5202005126
—
MI
Enumeration date
04/22/2019
Last updated
06/11/2019
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