Individual
JESSICA NICOLE WAGGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2701 CHESTNUT STATION CT, LOUISVILLE, KY 40299-6395
(800) 335-1060
Mailing address
738 WHITTLESEY ST, FREMONT, OH 43420-3347
(419) 603-0227
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A-1769514
OH
Other
Enumeration date
01/15/2019
Last updated
01/15/2019
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