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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Wednesday, December 18, 2024 6:43 PM CST
Next Update: Thursday, December 19, 2024 2:50 AM CST

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WAGNER, MICAIAH JOEL       
This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
Practice Address: EASTERN OKLAHOMA MEDICAL CENTER
105 S WALL STREET
POTEAU OK 74953

Address last updated on 11/7/2023
Phone #: (918) 635-3178
Fax #:
County: LEFLORE
License: 6526
Dated: 2/6/2024
Expires: 1/31/2025
Temp. Ltr. Issued: 12/22/2023
Temp. Ltr. Expires: 3/7/2024
License Type: Physical Therapist
Specialty:
Status: Active
Status Class: Fully Licensed
Restricted to:
CME Year: 2026
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Locations: Hours: Languages:
EASTERN OKLAHOMA MEDICAL CENTER
105 S WALL STREET
POTEAU OK 74953

Phone #: (918) 635-3178
Fax #:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
LINDA GAIL BAKER TA 491
AUDRIA JEAN MARIE BAXTER TA 1513
BRANDI MICHELLE GRUBBS TA 1188
LINDSEY ANN HACKNEY TA 1468
TRINITY NICOLE HOLTON TA 3681
JAMIE MICHELLE MAKOVY TA 1507
CHRISTY LEA REED TA 1864
ANNABELLA ROSE SAMO TA 3466
RICHARD ELYN SNIPES TA 1967

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