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General NPI Number Information
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NPI Number | 1386877132
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Entity Type | Individual
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Provider Name | JOY VERONICA WAGNER OTR, LMP
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Gender | Female
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Dates
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Enumeration Date | 08/27/2009
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Last Update Date | 01/20/2011
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Provider Practice Location Address
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Address Line | 2100 E UNION ST
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City | SEATTLE
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State | WA
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Zip | 98122-2954
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Country | US
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Telephone | 612-963-4119
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Fax |
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Provider Business Mailing Address
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Address Line | 938 26TH AVE
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City | SEATTLE
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State | WA
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Zip | 98122-4916
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Country | US
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Telephone | 612-963-4119
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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 | OT 60190874
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA 60201891
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License Number State | WA
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