Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OTR-1175 | WY |
NPI | 1841742111 |
---|---|
Provider Name | Maegan Wangler |
First Address | Wheatland, WY 82201-3508 |
Second Address | Wheatland, WY 82201-3162 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2016 |
Last Update Date | 02/11/2016 |