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1770943078
SAMANTHA ANN WAGNER
STILLWATER, OK
NPI
1770943078
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: OK 914)
Enumeration Date
2016-02-29
Last Update Date
2016-02-29
Business Address
-- SAMANTHA ANN WAGNER ATC, LAT, CES
170 ATHLETIC CTR
STILLWATER, OK 74078-0001
Phone number: 405-744-7823
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Mailing Address
-- SAMANTHA ANN WAGNER ATC, LAT, CES
4599 N WASHINGTON ST APT 4F
STILLWATER, OK 74075-1278
Phone number: 937-308-6354
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