Individual
MR. SCOTT ALLEN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSOTR/L
Contact information
Practice address
1615 CAPITOL WAY, BISMARCK, ND 58501-2218
(701) 751-0410
Mailing address
1615 CAPITOL WAY, BISMARCK, ND 58501-2218
(701) 751-0410
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
1131
ND
Other
Enumeration date
04/21/2010
Last updated
06/28/2021
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