MEDICARE: R&T WAGELIE THERAPY INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1831354240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R&T WAGELIE THERAPY INCORPORATED

Provider Business Mailing Address
First Line	:	5156 S 197TH AVENUE CIR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68135-3679
Country	:	US
Telephone Number	:	402-290-0931
Fax Number	:	402-597-0382

Provider Business Practice Location Address
First Line	:	5156 S 197TH AVENUE CIR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68135-3679
Country	:	US
Telephone Number	:	402-290-0931
Fax Number	:	402-597-0382

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RICK WAGELIE
Credential	:	O.T.
Telephone Number	:	402-290-0931

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	03/18/2015

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