Provider Demographics
NPI:1093390353
Name:WAGNER, SARAH ANNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ANNE
Other - Last Name:BODINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7418 223RD AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-7453
Mailing Address - Country:US
Mailing Address - Phone:253-307-5258
Mailing Address - Fax:
Practice Address - Street 1:107 1ST ST N
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7718
Practice Address - Country:US
Practice Address - Phone:360-458-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61132181225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist