Provider Demographics
NPI:1972874113
Name:WAGENSCHUTZ, TEIA ANN (CMT)
Entity Type:Individual
Prefix:
First Name:TEIA
Middle Name:ANN
Last Name:WAGENSCHUTZ
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 MARSH RD
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-9310
Mailing Address - Country:US
Mailing Address - Phone:269-685-5758
Mailing Address - Fax:
Practice Address - Street 1:995 MILLER RD
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-1077
Practice Address - Country:US
Practice Address - Phone:269-685-8034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist