Individual
STEVIE FANDANGO WAGAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
714 W PINE ST, NEWPORT, WA 99156-9046
(509) 447-2441
Mailing address
4509 E SILVER PINE RD, COLBERT, WA 99005-8707
(509) 230-7500
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OC60991827
WA
Other
Enumeration date
12/04/2020
Last updated
12/04/2020
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