Provider Demographics
NPI:1295151306
Name:WACHTER, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:WACHTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48944 TOWNSHIP ROAD 1059
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45772-9721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:723 SUMMERS ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-6022
Practice Address - Country:US
Practice Address - Phone:304-428-5573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV 1927224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant