Individual
SHINNAYHA NICOLE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13220 S 48TH ST APT 1112, PHOENIX, AZ 85044-5013
(928) 551-1020
Mailing address
13220 S 48TH ST APT 1112, PHOENIX, AZ 85044-5013
(928) 551-1020
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
7346
AZ
Other
Enumeration date
02/27/2018
Last updated
06/16/2018
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