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General NPI Number Information
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NPI Number | 1831495092
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Entity Type | Individual
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Provider Name | RAPHAELE JACQUELINE WAGNER MS,OTR/L
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Gender | Female
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Dates
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Enumeration Date | 02/07/2011
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 5690 F COACH HOUSE CIRCLE
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City | BOCA RATON
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State | FL
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Zip | 33486
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Country | US
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Telephone | 561-368-3008
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Fax |
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Provider Business Mailing Address
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Address Line | 1131 COVERBROOK LN
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City | SEBASTIAN
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State | FL
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Zip | 32958-5949
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Country | US
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Telephone | 954-593-5884
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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 | OT10833
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License Number State | FL
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