Individual
ALISA TABATHA WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
5910 RED OAK TRL, MC FARLAND, WI 53558-8828
(608) 217-9924
Mailing address
5910 RED OAK TRL, MC FARLAND, WI 53558-8828
(608) 217-9924
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4056-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
225X00000X
—
WI
Enumeration date
04/22/2009
Last updated
04/22/2009
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