Individual
SUSAN ROITH WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
500 UPPER CHESAPEAKE DR, BEL AIR, MD 21014-4324
(443) 643-1801
Mailing address
871 ELLICOTT DR, BEL AIR, MD 21015-3420
(443) 465-8457
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
02429
MD
Other
Enumeration date
06/08/2007
Last updated
12/17/2007
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