Individual
NICHOLE J WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Contact information
Practice address
604 E ASH AVE, GLEN ULLIN, ND 58631-7138
(701) 348-3107
Mailing address
PO BOX 161, GLEN ULLIN, ND 58631-0161
(218) 988-2871
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1961
ND
Other
Enumeration date
11/03/2022
Last updated
03/11/2025
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