Provider Demographics
NPI:1033258504
Name:HAGERTY, VALERIE BROCKEL (OTRL)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:BROCKEL
Last Name:HAGERTY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9403 WILLOW TREE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4693
Mailing Address - Country:US
Mailing Address - Phone:410-409-9504
Mailing Address - Fax:
Practice Address - Street 1:9403 WILLOW TREE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4693
Practice Address - Country:US
Practice Address - Phone:410-409-9504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7616225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist