Individual
LESA WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MTD
Contact information
Practice address
36 SW NYE ST, NEWPORT, OR 97365-3821
(541) 265-0445
(844) 760-0526
Mailing address
36 SW NYE ST, NEWPORT, OR 97365-3821
(541) 265-0445
(844) 760-0526
Taxonomy
Speciality
Code
Description
License number
State
225500000X
Respiratory/Developmental/Rehabilitative Specialist/Technologist
Primary
—
—
Other
Enumeration date
06/08/2021
Last updated
06/08/2021
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