Jacqueline Rae Wagner, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

6780-26 Issued in WI

Practice address

1818 Stone CRK
Hudson, WI 54016-9338

Phone

(715) 441-1003

NPI assigned

Nov 13, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• Key Corp

  • Community/Behavioral Health Agency
  • Saint Paul, MN
  • NPI 1447427877
  NPD (past)
• Key Corporation

  • Occupational Therapist
  • Saint Paul, MN
  • NPI 1639239445
  NPD (past)

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

{
    "created_epoch": "1226534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1861646010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1818 STONE CRK",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540169338",
            "telephone_number": "715-441-1003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 STONE CRK",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540169338",
            "telephone_number": "715-441-1003"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1246 University Ave W Ste 100",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551044183",
            "country_code": "US",
            "telephone_number": "651-603-8774 x15",
            "fax_number": "651-603-9009",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JACQUELINE",
        "middle_name": "RAE",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-11-13",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MN",
            "license": "103369",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "6780-26",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jessica@evolvewellot.com",
            "affiliation": "Y",
            "affiliationName": "Evolvewell Occupational Therapy LLC",
            "address_1": "5842 hobe ln",
            "city": "White Bear Lake",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551104183",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Savanna Vevang
• Andrew R Virata, M.D.
• Virginia Vogel
• Danielle A Wacker, OTR/L
• Carly Marie Wagner, MS, CCC-SLP
• Cortney Kim Wakefield, OTR/L
• Wal-Mart Stores East LP
• Jeryn Lee Waldera, BCBA
• Zachary Walgenbach, D.D.S.
• Walgreen Co

• Occupational Therapist in Hudson, WI
• Providers in Hudson, WI by specialty
• Occupational Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 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.