Individual
MICHELLE DAWN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
2335 E SAUNDERS ST # 3, LAREDO, TX 78041-5434
(956) 717-0441
Mailing address
141 HAZEL DR, VESTAL, NY 13850-3113
(607) 953-1361
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
012502
NY
Other
Enumeration date
04/13/2023
Last updated
04/13/2023
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