Jennifer L Wagner

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

212402 Issued in TX

Practice address

120 Meadow View Dr
Justin, TX 76247-9639

Phone

(940) 648-2731

NPI assigned

Jan 29, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548720000000",
    "number": "1003370545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10711 JUSTIN CEMETERY RD LOT 264",
            "city": "JUSTIN",
            "state": "TX",
            "postal_code": "762478032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MEADOW VIEW DR",
            "city": "JUSTIN",
            "state": "TX",
            "postal_code": "762479639",
            "telephone_number": "940-648-2731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-29",
        "last_updated": "2019-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "TX",
            "license": "212402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Baillie A Trumble, DC
• Khanh Truong, DDS
• Brookelynn Denise Trybull, DC, MSFN, BS
• Viva Homecare LLC
• Lauren Waddell, BCBA
• Christine Jean Walker, RNFA
• Riva Tarika Walker, DDS
• Karen E Walters, P.T.
• Anna Walton
• Courtney Blayne Atherton Ward, PT, DPT

• Occupational Therapy Assistant in Justin, TX
• Providers in Justin, TX by specialty
• Occupational Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.