NPIMap

Individual provider Active NPI

Lesa Wagner, MTD

  • Respiratory/Developmental/Rehabilitative Specialist/Technologist
  • Newport, OR
National Provider Identifier
1447827407
Registry record updated Jun 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Respiratory/Developmental/Rehabilitative Specialist/TechnologistTaxonomy code 225500000X
Practice address
36 SW Nye St
Newport, OR 97365-3821
Phone
(541) 265-0445
Fax
(844) 760-0526
NPI assigned
Jun 8, 2021
Last updated
Jun 8, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Respiratory/Developmental/Rehabilitative Specialist/Technologist 225500000X NU Primary

Addresses

Primary practice location

36 SW Nye St
Newport, OR 97365-3821

Mailing address

36 SW Nye St
Newport, OR 97365-3821
Phone (541) 265-0445

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

Organizations & group practices 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1623110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623110400000",
    "number": "1447827407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 SW NYE ST",
            "city": "NEWPORT",
            "state": "OR",
            "postal_code": "973653821",
            "telephone_number": "541-265-0445",
            "fax_number": "844-760-0526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 SW NYE ST",
            "city": "NEWPORT",
            "state": "OR",
            "postal_code": "973653821",
            "telephone_number": "541-265-0445",
            "fax_number": "844-760-0526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "LESA",
        "credential": "MTD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-08",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225500000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; 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.