Individual
LISA WAGGENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
620 SKYLINE DR, JACKSON, TN 38301-3923
(615) 495-6350
Mailing address
441 E CHESTER ST, SUITE 104, JACKSON, TN 38301-6313
(615) 495-6350
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3085
TN
Other
Enumeration date
11/20/2007
Last updated
12/10/2012
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