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General NPI Number Information
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NPI Number | 1356153787
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Entity Type | Individual
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Provider Name | HAILEY WAGNER OTR
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Gender | Female
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 529 WESTPORT RD
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2923
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Country | US
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Telephone | 270-807-0316
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Fax |
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Provider Business Mailing Address
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Address Line | 6584 STATE ROUTE 1245
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City | ROCKPORT
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State | KY
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Zip | 42369-9731
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Country | US
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Telephone | 812-598-9416
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 296345
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License Number State | KY
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