Provider Demographics
NPI:1164513743
Name:WAGGLE, SARA ELLEN
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:ELLEN
Last Name:WAGGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5TH AVE AND ROOSEVELT ROAD
Mailing Address - Street 2:HINES VA HOSPITAL
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141-5000
Mailing Address - Country:US
Mailing Address - Phone:708-202-7965
Mailing Address - Fax:708-202-7949
Practice Address - Street 1:5TH AVE AND ROOSEVELT ROAD
Practice Address - Street 2:HINES VA HOSPITAL
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-5000
Practice Address - Country:US
Practice Address - Phone:708-202-7965
Practice Address - Fax:708-202-7949
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind