Provider Demographics
NPI:1124387758
Name:HAGEMANN, DENISE MAE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:MAE
Last Name:HAGEMANN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1562 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-2417
Mailing Address - Country:US
Mailing Address - Phone:620-655-9461
Mailing Address - Fax:
Practice Address - Street 1:1562 MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-2417
Practice Address - Country:US
Practice Address - Phone:620-655-9461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2014-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012016604225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist