Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 102671 | MN |
NPI | 1053428532 |
---|---|
Provider Name | Cynthia L Wagner |
First Address | Saint Paul, MN 55104-3733 |
Second Address | Saint Paul, MN 55102-2383 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 16/01/2008 |