=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629923016
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOUISA ROSE WAGAMAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2026
-----------------------------------------------------
Last Update Date | 03/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5000 N 22ND ST
-----------------------------------------------------
City | OZARK
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65721-5116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-210-0539
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 812 E DYANN DR
-----------------------------------------------------
City | NIXA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65714-9323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-210-0539
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 2025045787
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------