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NPI Code Detail

MEDICARE: MRS. JULIE ANN WAGNER OTA-L

MEDICARE: MRS. JULIE ANN WAGNER OTA-L
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
1224Z00000XOccupational Therapy AssistantOTA.03263OH

General Provider Information

NPI Number : 1528264496
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JULIE ANN WAGNER OTA-L
Provider Business Mailing Address
First Line : 5438 CEDAR SPGS
Second Line :
City : COLUMBUS
State : OH
Zip : 43228-7200
Country : US
Telephone Number : 419-552-6279
Fax Number :
Provider Business Practice Location Address
First Line : 218 ELM ST
Second Line :
City : LONDON
State : OH
Zip : 43140-2130
Country : US
Telephone Number : 740-852-3100
Fax Number : 740-852-7266
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2007
Last Update Date : 07/08/2007

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