Individual
SANDRA KAY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
6131 IBISPARK DR, LITHIA, FL 33547-3909
(941) 722-6634
Mailing address
6131 IBISPARK DR, LITHIA, FL 33547-3909
(941) 722-6634
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA9826
FL
Other
Enumeration date
01/02/2008
Last updated
01/02/2008
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