| NPI | 1023759545 |
|---|---|
| Former Name | MOLLY MICHELE WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: NY 030580) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 031414) |
| Enumeration Date | 2022-04-06 |
| Last Update Date | 2025-09-15 |