| Doctor Name: | MRS. BONNY MICHELLE WAGNER |
| NPI Number: | 1114029204 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | OYR / CHT |
| License Number: | 0119000341 |
| Business Practice Address: | 663 Sunset Ln Culpeper, VA - 227013919 |
| Business Phone Number: | 5408255368 |
| Business Fax Number: | 5408290937 |
| Mailing Address: | 1503 Wrights Ln, RADIANT |
| State: | VA |
| Postal Code: | 227323254 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/01/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225XH1200X |
| License Number: | 0119000341 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Occupational Therapist |
| Taxonomy Specialization: | Hand |
| Taxonomy Definition: | |