Provider Demographics
NPI:1386877132
Name:WAGNER, JOY VERONICA (OTR, LMP)
Entity type:Individual
Prefix:MS
First Name:JOY
Middle Name:VERONICA
Last Name:WAGNER
Suffix:
Gender:F
Credentials:OTR, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:938 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4916
Mailing Address - Country:US
Mailing Address - Phone:612-963-4119
Mailing Address - Fax:
Practice Address - Street 1:2100 E UNION ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2954
Practice Address - Country:US
Practice Address - Phone:612-963-4119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 60190874225X00000X
WAMA 60201891225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist