| NPI | 1245678200 |
|---|---|
| Former Name | KATHRYN P WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: CO OT.0006653) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: WY COTA-1005) |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2020-12-02 |