Individual
MRS. KRISTIE LYNN WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2637 LAZY BEND ST STE 105, PEARLAND, TX 77581-1007
(713) 355-0623
Mailing address
2637 LAZY BEND STREET SUITE 105, PEARLAND, TX 77581
(713) 355-0623
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
110636
TX
Other
Enumeration date
10/02/2009
Last updated
10/02/2009
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