Provider Demographics
NPI:1235266594
Name:HAGBERG, TODD ALLEN (OTR)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:ALLEN
Last Name:HAGBERG
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 N BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-3418
Mailing Address - Country:US
Mailing Address - Phone:248-969-6965
Mailing Address - Fax:
Practice Address - Street 1:3655 S BALDWIN RD
Practice Address - Street 2:
Practice Address - City:ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-1506
Practice Address - Country:US
Practice Address - Phone:248-393-1699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist