| NPI | 1144964628 |
|---|---|
| Former Name | COURTNEY WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: UT 12151308-4201) |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2022-04-21 |
| Last Update Date | 2023-09-01 |