Basic Information
| Provider Information | |||||||||
| NPI: | 1124277991 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEGNER | ||||||||
| FirstName: | DEBBIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 S GLYNN AVE | ||||||||
| Address2: | |||||||||
| City: | QUITMAN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393552511 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1451 N LAKELAND DR | ||||||||
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| City: | MERIDIAN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393079020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012504815 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2008 | ||||||||
| LastUpdateDate: | 09/29/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT0177 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.