Individual
MRS. TERESA WAGELIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
5156 S 197TH AVENUE CIR, OMAHA, NE 68135-3679
(402) 290-0137
(402) 597-0382
Mailing address
5156 S 197TH AVENUE CIR, OMAHA, NE 68135-3679
(402) 290-0137
(402) 597-0382
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
424
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06584
BCBSNE
NE
Enumeration date
01/12/2007
Last updated
03/09/2015
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