Emily Grace Wagner, DT-C

Primary specialty

Developmental TherapistTaxonomy code 222Q00000X

License

NA

Practice address

11720 Plaza America Dr FL 9
Reston, VA 20190-4757

Phone

(866) 968-7512

NPI assigned

Aug 27, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pediplay LLC

  • Occupational Therapist
  • Indianapolis, IN
  • NPI 1679695381
  NPD (past)

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

{
    "created_epoch": "1535328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690761600000",
    "number": "1194206243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11720 PLAZA AMERICA DR FL 9",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201904757",
            "telephone_number": "866-968-7512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11720 PLAZA AMERICA DR FL 9",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201904757",
            "telephone_number": "866-968-7512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "EMILY",
        "middle_name": "GRACE",
        "name_prefix": "Miss",
        "credential": "DT-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-27",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": "IN",
            "license": "29001978A",
            "primary": false
        },
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": null,
            "license": "NA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anil Kumar Vuggam, D.M.D
• Drazan Vukovic, ATC
• Thao Ngoc Vuong, PHARM.D.
• Elizabeth Wachira, LPN
• Natalie Moss Waggener, PHD
• Robin Wagner, PT, DPT
• Leal Simon Wai, R.PH
• Walgreen Co
• Walgreen Co
• Lauren King Wall, PSY.D.

• Developmental Therapist in Reston, VA
• Providers in Reston, VA by specialty
• Developmental Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; 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.