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General NPI Number Information
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NPI Number | 1265956239
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Entity Type | Individual
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Provider Name | CHERYL LYNN WAGNER
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Gender | Female
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Dates
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Enumeration Date | 08/01/2017
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Last Update Date | 08/01/2017
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Provider Practice Location Address
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Address Line | 300 WREN ST SACANDAGA SCHOOL
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City | SCOTIA
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State | NY
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Zip | 12302
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Country | US
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Telephone | 518-386-4311
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Fax |
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Provider Business Mailing Address
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Address Line | 1 RAPP RD ADVANCED THERAPY
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City | ALBANY
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State | NY
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Zip | 12203
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Country | US
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Telephone | 518-867-3061
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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