Individual
MS. RACHELLE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
304 E 6TH AVE, ROME, GA 30161-6000
(706) 378-9044
(706) 378-9046
Mailing address
20 GREATWOOD DR, WHITE, GA 30184-2893
(706) 378-9044
(706) 378-9046
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
OT003702
GA
225X00000X
Occupational Therapist
Primary
OT003702
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10047143
—
GA
05
—
342685
—
GA
01
—
52038467
BLUE CROSS BLUE SHIELD
GA
Enumeration date
11/20/2006
Last updated
09/11/2025
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