Phyllis J Wagner

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

000798-1 Issued in NY

Practice address

4635 Union Rd
Cheektowaga, NY 14225-1851

Phone

(716) 505-5700

Fax

(716) 633-9351

NPI assigned

Aug 17, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Aspire Wny

  • Early Intervention Provider Agency
  • Cheektowaga, NY
  • NPI 1386905115
  NPD (past)
• Aspire Wny

  • Early Intervention Provider Agency
  • Cheektowaga, NY
  • NPI 1790031201
  NPD (past)

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770697096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1054 NIAGARA FALLS BLVD",
            "city": "NORTH TONAWANDA",
            "state": "NY",
            "postal_code": "141201220",
            "telephone_number": "716-695-2157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4635 UNION RD",
            "city": "CHEEKTOWAGA",
            "state": "NY",
            "postal_code": "142251851",
            "telephone_number": "716-505-5700",
            "fax_number": "716-633-9351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "PHYLLIS",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "NY",
            "license": "000798-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapy Assistant in Cheektowaga, NY
• Providers in Cheektowaga, NY by specialty
• Occupational Therapy Assistant in New York

• 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.

Verify at the official NPI Registry.