Provider Demographics
NPI:1164689261
Name:HAGIE, AMANDA ELAINE (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:ELAINE
Last Name:HAGIE
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 1:2120 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1112
Mailing Address - Country:US
Mailing Address - Phone:865-525-4133
Mailing Address - Fax:
Practice Address - Street 1:2120 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1112
Practice Address - Country:US
Practice Address - Phone:865-525-4133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-18
Last Update Date:2008-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3344174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist