Provider Demographics
NPI:1770074924
Name:WAGNER, FRANCESCA
Entity type:Individual
Prefix:
First Name:FRANCESCA
Middle Name:
Last Name:WAGNER
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 1:21483 CARLTON DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-1859
Mailing Address - Country:US
Mailing Address - Phone:586-850-1141
Mailing Address - Fax:
Practice Address - Street 1:42700 GARFIELD RD STE 110
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-4201
Practice Address - Country:US
Practice Address - Phone:586-532-3356
Practice Address - Fax:586-416-1560
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000420225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics