Organization
HOME AND COMMUNITY RECREATION THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE PENNY WAGNER-HEFFNER MA, CTRS (OWNER)
(734) 355-3899
Entity
Organization
Contact information
Practice address
1810 TIMBER TRL, ANN ARBOR, MI 48103-2392
(734) 355-3899
Mailing address
1810 TIMBER TRAIL, ANN ARBOR, MI 48103
(734) 355-3899
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
—
—
Other
Enumeration date
10/22/2012
Last updated
10/25/2012
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