Individual
MR. ANTHONY CHARLES WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
3001 GREEN BAY RD, NORTH CHICAGO, IL 60064-3048
(847) 688-1900
Mailing address
10064 51ST CT, PLEASANT PRAIRIE, WI 53158-3398
(847) 688-1900
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056.006368
IL
Other
Enumeration date
08/20/2006
Last updated
11/17/2009
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