Provider Demographics
NPI:1689905580
Name:WAEGNER, NANETTE LYNN (MOTR)
Entity type:Individual
Prefix:
First Name:NANETTE
Middle Name:LYNN
Last Name:WAEGNER
Suffix:
Gender:F
Credentials:MOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8619 BROADWAY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8782
Mailing Address - Country:US
Mailing Address - Phone:281-485-4818
Mailing Address - Fax:281-485-5446
Practice Address - Street 1:8619 BROADWAY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8782
Practice Address - Country:US
Practice Address - Phone:281-485-4818
Practice Address - Fax:281-485-5446
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113227225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist