MEDICARE: ALETA D WAGNER OTR/L

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	225X00000X	Occupational Therapist	2815	CO

General Provider Information

NPI Number	:	1851536783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALETA D WAGNER OTR/L

Provider Business Mailing Address
First Line	:	251 FRONT ST STE 10
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-9137
Country	:	US
Telephone Number	:	719-481-3121
Fax Number	:	719-481-3121

Provider Business Practice Location Address
First Line	:	251 FRONT ST STE 10
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-9137
Country	:	US
Telephone Number	:	719-481-3121
Fax Number	:	719-481-3121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2008
Last Update Date	:	10/26/2025

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