MEDICARE: LOUISA ROSE WAGAMAN

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
1	225700000X	Massage Therapist	2025045787	MO

General Provider Information

NPI Number	:	1629923016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUISA ROSE WAGAMAN

Provider Business Mailing Address
First Line	:	812 E DYANN DR
Second Line	:
City	:	NIXA
State	:	MO
Zip	:	65714-9323
Country	:	US
Telephone Number	:	417-210-0539
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000 N 22ND ST
Second Line	:
City	:	OZARK
State	:	MO
Zip	:	65721-5116
Country	:	US
Telephone Number	:	417-210-0539
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “ LOUISA ROSE WAGAMAN ” Practice Location

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