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General NPI Number Information
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NPI Number | 1417667114
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Entity Type | Individual
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Provider Name | KAREN WAGNER (R) R.T., FCC
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Gender | Female
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Dates
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Enumeration Date | 12/02/2022
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 442 WATERVLIET AVE
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City | DAYTON
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State | OH
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Zip | 45420-2467
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Country | US
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Telephone | 937-344-0110
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Fax |
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Provider Business Mailing Address
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Address Line | 442 WATERVLIET AVE
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City | DAYTON
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State | OH
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Zip | 45420-2467
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Country | US
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Telephone | 937-344-0110
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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 | 225500000X
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Taxonomy Name | Respiratory/Developmental/Rehabilitative Specialist/Technologist
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License Number | 433896
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number | 433896
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License Number State | OH
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