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NPI Code Detail

MEDICARE: MS. RACHELLE WAGNER OTRL

MEDICARE: MS. RACHELLE WAGNER OTRL
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
1171W00000XContractorOT003702GA
2225X00000XOccupational TherapistOT003702GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
352038467OTHERGABLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1841364999
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RACHELLE WAGNER OTRL
Provider Business Mailing Address
First Line : 20 GREATWOOD DR
Second Line :
City : WHITE
State : GA
Zip : 30184-2893
Country : US
Telephone Number : 706-378-9044
Fax Number : 706-378-9046
Provider Business Practice Location Address
First Line : 304 E 6TH AVE
Second Line :
City : ROME
State : GA
Zip : 30161-6000
Country : US
Telephone Number : 706-378-9044
Fax Number : 706-378-9046
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2006
Last Update Date : 09/11/2025

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Directions to “ MS. RACHELLE WAGNER OTRL” Practice Location

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