Provider Demographics
NPI:1720186828
Name:WAGNER, CHRISTI LYN (OTR)
Entity Type:Individual
Prefix:
First Name:CHRISTI
Middle Name:LYN
Last Name:WAGNER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14611 DAWN VALE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-2128
Mailing Address - Country:US
Mailing Address - Phone:281-280-8379
Mailing Address - Fax:
Practice Address - Street 1:2002 HOLCOMB BLVD.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4298
Practice Address - Country:US
Practice Address - Phone:713-794-7793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5183225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist