Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Andrew Wagner

Individual provider Social Worker · NPI 1073900320

Andrew Wagner is an Occupational Therapist in Private Practice in Gresham, Oregon. Qualified in 2019, 7 years ago. Practices with Sportscare Physical Therapy @ Cornell, LLC, a 35-clinician group and accepts Medicare assignment. Licensed in Oregon.

Years since qualifying
7
Licensed in
OR
In the registry since
2015
Specialties on file
2
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Practice location Address checks out

24076 SE Stark St Ste 200
Gresham, OR 97030-3376
Phone: (503) 674-7860
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Hand Occupational Therapist (primary) Taxonomy 225XH1200X · Licence 423249 (OR)
Social Worker Taxonomy 104100000X (OR)

Record details

NPI number1073900320
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 23, 2015
Last updated in NPPESNovember 29, 2022
Certification dateNovember 29, 2022
Mailing address24076 Se Stark St Ste 200, Gresham, OR 97030-3376

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOCCUPATIONAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Sportscare Physical Therapy @ Cornell, Llc — 35 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Gresham