Individual
CARA DANIELLE WAGSTAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
5947 FM 2864 LOT 3, NACOGDOCHES, TX 75965-8929
(936) 553-9129
Mailing address
5947 FM 2864 LOT 3, NACOGDOCHES, TX 75965-8929
(936) 553-9129
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
218047
TX
Other
Enumeration date
02/27/2024
Last updated
02/27/2024
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