Individual
SANDRA M WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
410 ALBEMARLE SQ, CHARLOTTESVILLE, VA 22901-7400
(434) 817-4278
Mailing address
PO BOX 1583, CHARLOTTESVILLE, VA 22902-1583
(434) 654-7794
(434) 654-7752
Taxonomy
Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
Primary
0119000123
VA
Other
Enumeration date
01/11/2007
Last updated
12/20/2010
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