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General NPI Number Information
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NPI Number | 1124581855
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Entity Type | Individual
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Provider Name | SHARON DARLENE WAGNER
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Gender | Female
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Dates
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Enumeration Date | 04/10/2019
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Last Update Date | 04/10/2019
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Provider Practice Location Address
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Address Line | 440 INGRAM DR
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City | KING
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State | NC
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Zip | 27021-8208
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Country | US
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Telephone | 336-983-4900
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 167
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City | PINE HALL
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State | NC
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Zip | 27042-0167
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Country | US
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Telephone | 336-750-7410
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Fax |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 11693
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License Number State | NC
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