Michael Charles Wagner

NPI #1235585191 in Nampa, Idaho

Provider Information

NPI Number: 1235585191
Entity Type: Individual
Name: Michael Charles Wagner
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Occupational Therapist
Enumeration Date: May 10, 2016
Last Updated: May 10, 2016

Practice Location

Address: 170 2ND ST S
City: Nampa
State: Idaho
ZIP Code: 83651-3708
Phone: (208) 385-3651

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Occupational Therapist	225X00000X	Primary

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