Provider Demographics
NPI:1053552687
Name:WAGLER, SERENA JOY (COTA)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:JOY
Last Name:WAGLER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12634 1/2 SPENCERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:IN
Mailing Address - Zip Code:46743-7498
Mailing Address - Country:US
Mailing Address - Phone:812-787-0471
Mailing Address - Fax:
Practice Address - Street 1:12634 1/2 SPENCERVILLE RD
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IN
Practice Address - Zip Code:46743-7498
Practice Address - Country:US
Practice Address - Phone:812-787-0471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist