Individual
LISA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DHS, OTR/L
Contact information
Practice address
1400 GRIFFIN MILL RD, EASLEY, SC 29640-6929
(864) 397-1059
Mailing address
1400 GRIFFIN MILL RD, EASLEY, SC 29640-6929
(864) 397-1059
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
SC
Other
Enumeration date
10/20/2014
Last updated
10/20/2014
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