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NPI Code Detail

MEDICARE: ELIZABETH WAGNER OT

MEDICARE: ELIZABETH WAGNER OT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist110301TX

General Provider Information

NPI Number : 1023343647
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH WAGNER OT
Provider Business Mailing Address
First Line : 9505 NORTHPOINTE BLVD
Second Line :
City : SPRING
State : TX
Zip : 77379-3799
Country : US
Telephone Number : 281-430-4945
Fax Number : 281-430-4225
Provider Business Practice Location Address
First Line : 9505 NORTHPOINTE BLVD
Second Line :
City : SPRING
State : TX
Zip : 77379-3799
Country : US
Telephone Number : 281-430-4945
Fax Number : 281-430-4225
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2009
Last Update Date : 10/15/2009

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