Individual
PHYLLIS J WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4635 UNION RD, CHEEKTOWAGA, NY 14225-1851
(716) 505-5700
(716) 633-9351
Mailing address
1054 NIAGARA FALLS BLVD, NORTH TONAWANDA, NY 14120-1220
(716) 695-2157
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
000798-1
NY
Other
Enumeration date
08/17/2006
Last updated
07/08/2007
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