Individual
MS. JONI LYNNE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1431 GREENWAY DR STE 500, IRVING, TX 75038-2444
(806) 553-7778
Mailing address
6178 COUNTY ROAD G, VEGA, TX 79092-3023
(806) 881-9048
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
216974
TX
Other
Enumeration date
09/09/2021
Last updated
09/09/2021
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