Individual
KIMBERLY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, OTRL
Contact information
Practice address
23936 MICHIGAN AVE, DEARBORN, MI 48124-1833
(313) 278-4601
Mailing address
15045 BELMONT AVE, ALLEN PARK, MI 48101-1605
(313) 378-6648
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5201001795
MI
225X00000X
Occupational Therapist
5201001795
MI
Other
Enumeration date
03/07/2015
Last updated
07/30/2019
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