Scott Allen Wagner, MSOTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

1131 Issued in ND

Practice address

1615 Capitol Way
Bismarck, ND 58501-2218

Phone

(701) 751-0410

NPI assigned

Apr 21, 2010

Sex

Male

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

Enrolled in ND

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Little Lights Pediatric Therapy, LLC

  • Occupational Therapist
  • Bismarck, ND
  • NPI 1083121792
  Medicare reassignment NPD

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

{
    "created_epoch": "1271808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624838400000",
    "number": "1538486162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 CAPITOL WAY",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585012218",
            "telephone_number": "701-751-0410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 CAPITOL WAY",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585012218",
            "telephone_number": "701-751-0410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "SCOTT",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "credential": "MSOTR/L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-21",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "ND",
            "license": "1131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wagner Chiropractic, PC
• Ashley Lynn Wagner, D.C.
• Barry D Wagner, DC
• Faith M Wagner, FNP-C
• Michelle Wagner, RD,LRD
• Sheila Wagner, FNP-C
• Parveen Suhara Wahab, M.D
• Amber Wahl, PT
• Charito Wahl
• Haleigh Diane Wahl

• Pediatric Occupational Therapist in Bismarck, ND
• Providers in Bismarck, ND by specialty
• Pediatric Occupational Therapist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.