Provider Demographics
NPI:1255618211
Name:WAGNER, KATHRYN ANN (MS, OTR)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ANN
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6572 POWERS RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-4804
Mailing Address - Country:US
Mailing Address - Phone:716-818-2800
Mailing Address - Fax:
Practice Address - Street 1:6572 POWERS RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-4804
Practice Address - Country:US
Practice Address - Phone:716-818-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004236-1251300000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No251E00000XAgenciesHome Health