Provider Demographics
NPI:1548968100
Name:OASIS THERAPY CENTER, LLC
Entity type:Organization
Organization Name:OASIS THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW, RPT-S
Authorized Official - Phone:507-475-2213
Mailing Address - Street 1:1610 14TH ST NW STE 301
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-0229
Mailing Address - Country:US
Mailing Address - Phone:507-419-4347
Mailing Address - Fax:
Practice Address - Street 1:1610 14TH ST NW STE 301
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-0229
Practice Address - Country:US
Practice Address - Phone:507-419-4347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty