Doctor Name: | KANDY KAY WAGNER |
NPI Number: | 1306166723 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.T. |
License Number: | 332924-00 |
Business Practice Address: | 21526 Harper Ave St. Clair Shores, MI - 48080 |
Business Phone Number: | 5862425729 |
Business Fax Number: | |
Mailing Address: | 38815 Lakeshore Drive, HARRISON TOWNSHIP |
State: | MI |
Postal Code: | 48045 |
Phone Number: | 5862425729 |
Fax Number: | |
NPI Enumeration Date: | 06/08/2010 |
NPI Last Update Date: | 06/08/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 332924-00 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |