Individual
KRISTY E WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
225 MEMORIAL DRIVE, BERLIN, WI 54923
(920) 361-5534
Mailing address
6709 WHITETAIL DRIVE, WINNECONNE, WI 54986-8717
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4761027
WI
Other
Enumeration date
05/11/2011
Last updated
05/11/2011
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