Active NPI
Adelyn Lee Wagner, OTRL
- Occupational Therapist
- Hermann, MO
National Provider Identifier
1699830331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 000587
- Practice address
- 509 W. 18TH St.
Hermann, MO 65041-0470 - Phone
- (573) 486-2191
- Fax
- (573) 486-5021
- NPI assigned
- Dec 22, 2006
- Last updated
- Jul 8, 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 | 000587 | MO | Primary |
Addresses
Primary practice location
509 W. 18TH St.
Hermann, MO 65041-0470
Mailing address
623 Epple Fricke Dr
Hermann, MO 65041-1703
Phone (573) 486-5473
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 |
|---|---|---|---|
| 000587 | MO | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699830331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "623 EPPLE FRICKE DR",
"city": "HERMANN",
"state": "MO",
"postal_code": "650411703",
"telephone_number": "573-486-5473"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "509 W. 18TH ST.",
"city": "HERMANN",
"state": "MO",
"postal_code": "650410470",
"telephone_number": "573-486-2191",
"fax_number": "573-486-5021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "ADELYN",
"middle_name": "LEE",
"name_prefix": "Ms.",
"credential": "OTRL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MO",
"license": "000587",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hermann, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.