Most Relevant Information
Provider Data
| NPI Number: | 1003370545 |
| Provider Name: | JENNIFER L WAGNER |
| Entity Type: | Individual |
| Taxonomy Code: | 224Z00000X |
| Specialty: | Occupational Therapy Assistant |
| License Number: | 212402 |
Most Important Dates
| Enumeration Date: | 01/29/2019 |
| Last Updated: | 01/29/2019 |
Provider Practice Location
120 MEADOW VIEW DR
JUSTIN
TX
762479639
Practice Location Phone/Fax
| Phone: | 9406482731 |
| Fax: |
Provider Mailing Location
10711 JUSTIN CEMETERY RD LOT 264
JUSTIN
TX
762478032
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |