| NPI | 1114061611 |
|---|---|
| Former Name | MICHELLE LYNNE WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XH1200X Occupational Therapist Hand (Licence: WY OT814) |
| Additional Taxonomies | 225XP0019X Occupational Therapist Physical Rehabilitation (Licence: WY OT-814) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2025-04-07 |