| NPI | 1629430541 |
|---|---|
| Former Name | KELSEY WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Z00000X Orthotist |
| Additional Taxonomies | 224L00000X |
| 225000000X Orthotic Fitter | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2016-03-22 |