Individual
MRS. JENNIFER LYNN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSOTR/L
Contact information
Practice address
206 DEERLEA LN, BOONTON, NJ 07005-9511
(973) 632-6487
Mailing address
206 DEERLEA LN, BOONTON, NJ 07005-9511
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46TR00228800
NJ
Other
Enumeration date
08/16/2007
Last updated
08/16/2007
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