Individual
LACY JAYE WAGGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
601 E NODAWAY ST, OREGON, MO 64473-9602
(660) 572-0433
Mailing address
200 OAKLAND ST, OREGON, MO 64473-9200
(660) 446-2650
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2013033098
MO
Other
Enumeration date
12/06/2017
Last updated
12/06/2017
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