Individual
DIANE MAY VAN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
411 OAK ST, CINCINNATI, OH 45219-2504
(513) 984-4909
Mailing address
1321 E SCOTT ST, PENSACOLA, FL 32503-4656
(850) 861-1138
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
25588
FL
225XP0200X
Pediatric Occupational Therapist
7400
CA
Other
Enumeration date
05/25/2011
Last updated
04/07/2026
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