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General NPI Number Information
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NPI Number | 1447348420
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Entity Type | Individual
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Provider Name | CHERYL A WAGNER OT
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Gender | Female
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1331 E 4TH ST
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City | OTTAWA
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State | OH
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Zip | 45875-1545
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Country | US
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Telephone | 419-523-9337
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Fax | 419-523-6323
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Provider Business Mailing Address
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Address Line | 12483 ROAD 12-H
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City | OTTAWA
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State | OH
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Zip | 45875
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Country | US
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Telephone | 419-447-7203
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Fax | 419-447-5577
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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 | 006086
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License Number State | OH
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