Active NPI
Wendy R Wagner, OTR
- Occupational Therapist
- Palestine, TX
National Provider Identifier
1295922029
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 107413
- Practice address
- 1501 S Loop 256
Apt. #1416
Palestine, TX 75801-5861 - Phone
- (903) 391-0309
- NPI assigned
- Sep 25, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 107413 | TX | Primary |
Addresses
Primary practice location
1501 S Loop 256
Apt. #1416
Palestine, TX 75801-5861
Mailing address
1501 S Loop 256
Apt. #1416
Palestine, TX 75801-5861
Phone (903) 391-0309
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107413 | TX | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190678400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190678400000",
"number": "1295922029",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 S LOOP 256",
"address_2": "APT. #1416",
"city": "PALESTINE",
"state": "TX",
"postal_code": "758015861",
"telephone_number": "903-391-0309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 S LOOP 256",
"address_2": "APT. #1416",
"city": "PALESTINE",
"state": "TX",
"postal_code": "758015861",
"telephone_number": "903-391-0309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "WENDY",
"middle_name": "R",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-25",
"last_updated": "2007-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "107413",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palestine, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.