Individual
JORDYN H WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
4715 WHITESBURG DR SE STE 100, HUNTSVILLE, AL 35802-1632
(256) 319-8500
Mailing address
251 JOHNSTON ST SE STE 200, DECATUR, AL 35601-2515
(256) 350-1764
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5312
AL
Other
Enumeration date
06/23/2020
Last updated
06/23/2020
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