Provider Demographics
NPI:1669040978
Name:WAGNER, MICHAELA M (RBT)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:M
Last Name:WAGNER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RATHTON RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3717
Mailing Address - Country:US
Mailing Address - Phone:717-885-5906
Mailing Address - Fax:717-600-8179
Practice Address - Street 1:1 RATHTON RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3717
Practice Address - Country:US
Practice Address - Phone:717-885-5906
Practice Address - Fax:717-600-8179
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARBT-21-171207106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician