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General NPI Number Information
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NPI Number | 1376338517
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Entity Type | Organization
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Legal Business Name | WAVE WELLNESS
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 06/14/2025
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Provider Practice Location Address
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Address Line | 116 AGNES RD
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City | KNOXVILLE
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State | TN
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Zip | 37919-6306
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Country | US
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Telephone | 423-464-3840
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Fax |
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Provider Business Mailing Address
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Address Line | 2383 WORTH LN NW
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City | CHARLESTON
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State | TN
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Zip | 37310-6655
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | JENNA WOZNIAK
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Credential | OTR/L
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Telephone | 860-817-2818
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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 |
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License Number State |
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