Individual
MRS. BRENDA KAY WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
151 2ND ST, SPRING ARBOR, MI 49283-9647
(517) 750-4412
Mailing address
12614 SLEE RD, MANITOU BEACH, MI 49253-9739
(517) 605-8901
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202006840
MI
Other
Enumeration date
08/14/2009
Last updated
08/14/2009
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