| Doctor Name: | PATRICIA ANNE WAGNER |
| NPI Number: | 1215332705 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 3348 |
| Business Practice Address: | 1401 Blackfoot Trl Woodland Park, CO - 808638304 |
| Business Phone Number: | 7196861938 |
| Business Fax Number: | |
| Mailing Address: | 1401 Blackfoot Trl, WOODLAND PARK |
| State: | CO |
| Postal Code: | 808638304 |
| Phone Number: | 7196861938 |
| Fax Number: | |
| NPI Enumeration Date: | 10/27/2014 |
| NPI Last Update Date: | 10/27/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2255R0406X |
| License Number: | 3348 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CO |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Specialist/Technologist |
| Taxonomy Specialization: | Rehabilitation, Blind |
| Taxonomy Definition: | |