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General NPI Number Information
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NPI Number | 1114183357
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Entity Type | Individual
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Provider Name | AMY M WAGNER ED.S., BCABA
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Gender | Female
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Dates
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Enumeration Date | 08/06/2008
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 9402 BULLFROG CT
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City | GIBSONTON
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State | FL
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Zip | 33534-5100
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Country | US
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Telephone | 813-335-8296
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Fax | 813-671-4645
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Provider Business Mailing Address
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Address Line | PO BOX 1275
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City | RIVERVIEW
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State | FL
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Zip | 33568-1275
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Country | US
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Telephone | 813-335-8296
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Fax | 813-671-4645
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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