Provider Demographics
NPI:1043362254
Name:HAGEMAN, DENISE RENEA (OTR)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:RENEA
Last Name:HAGEMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N MAIN ST
Mailing Address - Street 2:PO BOX 46
Mailing Address - City:KINGMAN
Mailing Address - State:KS
Mailing Address - Zip Code:67068-1335
Mailing Address - Country:US
Mailing Address - Phone:620-532-3300
Mailing Address - Fax:620-532-3635
Practice Address - Street 1:301 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:KS
Practice Address - Zip Code:67068-1335
Practice Address - Country:US
Practice Address - Phone:620-532-3300
Practice Address - Fax:620-532-3635
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01630225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS013620Medicare UPIN