Provider Demographics
NPI:1528394046
Name:WAGANER, MELISSA BROOKE (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:BROOKE
Last Name:WAGANER
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:REGIONAL THERAPY SERVICES
Mailing Address - Street 2:2510 W HUDSON RD
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756
Mailing Address - Country:US
Mailing Address - Phone:803-795-9292
Mailing Address - Fax:
Practice Address - Street 1:REGIONAL THERAPY SERVICES
Practice Address - Street 2:2510 W HUDSON RD
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756
Practice Address - Country:US
Practice Address - Phone:479-936-1061
Practice Address - Fax:855-812-1132
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3392225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics