Individual
JACQUELINE RAE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1818 STONE CRK, HUDSON, WI 54016-9338
(715) 441-1003
Mailing address
1818 STONE CRK, HUDSON, WI 54016-9338
(715) 441-1003
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
103369
MN
225X00000X
Occupational Therapist
Primary
6780-26
WI
225X00000X
Occupational Therapist
—
—
Other
Enumeration date
11/13/2008
Last updated
03/22/2021
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