Individual
AMELIA WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3209 CYPRESS GROVE DR, EUSTIS, FL 32736-2503
(352) 409-2091
Mailing address
3209 CYPRESS GROVE DR, EUSTIS, FL 32736-2503
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/31/2023
Last updated
08/31/2023
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