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General NPI Number Information
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NPI Number | 1972088789
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Entity Type | Individual
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Provider Name | ALEXIS BROOKE WAGNER OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/27/2018
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Last Update Date | 09/27/2018
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Provider Practice Location Address
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Address Line | 3200 VINE ST
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City | CINCINNATI
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State | OH
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Zip | 45220-2213
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Country | US
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Telephone | 513-861-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 108 N WILLOW ST
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City | BROOKSVILLE
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State | KY
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Zip | 41004-8304
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Country | US
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Telephone | 606-782-2888
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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 | OT010334
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License Number State | OH
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