Individual
MS. ADELYN LEE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
509 W. 18TH ST., HERMANN, MO 65041-0470
(573) 486-2191
(573) 486-5021
Mailing address
623 EPPLE FRICKE DR, HERMANN, MO 65041-1703
(573) 486-5473
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
000587
MO
Other
Enumeration date
12/22/2006
Last updated
07/08/2007
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