Individual
JENNIFER WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
20329 N 59TH AVE, GLENDALE, AZ 85308-6853
(623) 500-2401
(623) 500-2401
Mailing address
7505 S 14TH ST, PHOENIX, AZ 85042-5666
(602) 349-8212
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
7165
AZ
Other
Enumeration date
10/23/2017
Last updated
06/18/2019
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