GARY LEE WAGNER (NPI# 1316190820) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316190820 |
| Entity Type | Individual |
| Full Name | GARY LEE WAGNER |
| Practice Address |
897 Lilac Rd Beloit WI 53511-1627 |
| Practice Telephone | 6082906705 |
| Mailing Telephone | 6082906705 |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2008-10-28 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 222Q00000X | Developmental Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962944892 | Gary Wagner | Respiratory Therapist, Registered | 3601 S 6th Ave, Tucson, AZ 85723-0001 | 2016-11-09 |
| 1699842229 | Gary L. Wagner | Registered Nurse | 2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051 | 2006-11-29 |
| 1235160102 | Gary Wagner | Dermatology | 600 Coffee Rd, Modesto, CA 95355-4201 | 2006-07-06 |
| Street Address |
897 LILAC RD |
| City | BELOIT |
| State | WI |
| Zip Code | 53511-1627 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730738485 | Linda Lee Cook | Technician | 914 Cranston Rd., Beloit, WI 53511 | 2019-09-05 |
| 1033773734 | Holistic Counseling Services, LLC | Counselor | 1517 Huebbe Parkway, Ste A, Beloit, WI 53511 | 2019-04-28 |
| 1578073870 | Bonita May Cooke | Counselor | 838 Grant St., Beloit, WI 53511 | 2017-10-02 |
| 1679091219 | Stacy Lynn Gallagher | Licensed Practical Nurse | 1060 Bittel St, Beloit, WI 53511 | 2017-09-04 |
| 1629448824 | Brenda Jean Allen | Registered Nurse | 2907 E. Leona Drive, Beloit, WI 53511 | 2015-09-30 |
| 1033595038 | Amber Noel Slaybaugh | Physical Therapist | 838 E. Azalea Ter., Beloit, WI 53511 | 2015-08-03 |
| 1407260326 | Quirt Family Dentistry, Sc | Dentist | 2777 Milwaukee Rd, Beloit, WI 53511 | 2014-06-18 |
| 1821436973 | Raymond K Spade | Counselor | 2240 Prairie Ave., Beloit, WI 53511 | 2013-06-11 |
| 1629321658 | Sarah Ann Nelson | Physical Therapist | 1905 W. Hart Road, Beloit, WI 53511 | 2012-10-15 |
| 1235494212 | Mary Ann Hudson | Nurse Practitioner | 700 College Street, Beloit College, Beloit, WI 53511 | 2012-07-06 |
| Find all providers in zip 53511 | ||||
| Taxonomy Code | 222Q00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Developmental Therapist |
| A Developmental Therapist is a person qualified by completion of an approved program in Developmental Therapy and where applicable credentialed by the state and practicing within the scope of the credential, or credentialed by completion of education experiences as approved by the state and practicing within the scope of that credential or, where state credentialing does not exist, certified by the Board of the Developmental Therapy Association. A developmental therapist evaluates children's global development in order to identify areas of developmental delay whether arising from physiological, neurological, or environmental factors, or a combination of factors; and designs, implements, and modifies therapeutic interventions for the child and the family to promote the child's acquisition of skills in a variety of developmental areas, including cognitive processes and social interaction in order to maximize functional independence and developmental homeostasis, and improve the quality of life at home and in the community; and provides consultation for the parents and other professionals working with the family on global development. |
| Notes: Source: The Illinois Developmental Therapists Association [1/1/2007: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063621498 | Michelle Lea Fulk | Developmental Therapist | 2530 Shady Ln, Beloit, WI 53511-7029 | 2007-05-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104460310 | Juliane Korman | Developmental Therapist | 8930 Sheridan Rd Apt 19, Kenosha, WI 53143-6901 | 2019-10-30 |
| 1750845434 | Linda Anne Bailey | Developmental Therapist | 1514 Linden Ave, Janesville, WI 53548-2831 | 2019-01-26 |
| 1477085819 | Joyan Sanios | Developmental Therapist | 454 N Lakeshore Dr, Fontana, WI 53125-1118 | 2017-04-03 |
| 1336599810 | Kateri Lynne Gullifor | Developmental Therapist | 1950 Sunset Dr, Twin Lakes, WI 53181-9235 | 2016-06-15 |
| 1295100873 | Lindsay Zimmerman | Developmental Therapist | 1400 Somerset Dr, Stevens Point, WI 54482-9425 | 2015-12-07 |
| 1114266699 | Nadia Marie Hernandez | Developmental Therapist | 3421 121st Pl, Pleasant Prairie, WI 53158-4264 | 2013-02-04 |
| 1235484874 | Lisa A Dillhunt | Developmental Therapist | 209 S Huron St, De Pere, WI 54115-2820 | 2012-07-19 |
| 1659601201 | Kara Sue Bader | Developmental Therapist | 981 Stratford Ct, Racine, WI 53406-7003 | 2010-01-04 |
| 1679795314 | Jennifer Ann Frisby | Developmental Therapist | 40157 105th St, Genoa City, WI 53128-2293 | 2007-05-03 |
| 1912381682 | Shua-see Yang | Developmental Therapist | 2222 S 114th St, West Allis, WI 53227-1031 | 2015-07-13 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.