Individual
ILSE WAGENBACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13147 HIGHWAY 67 W, BUTLER, TN 37640-7218
(423) 609-0133
Mailing address
13147 HIGHWAY 67 W, BUTLER, TN 37640-7218
(423) 609-0133
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
TN
Other
Enumeration date
10/09/2025
Last updated
10/09/2025
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