Provider Demographics
NPI:1235729047
Name:TRANUM, KAGEN LEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KAGEN
Middle Name:LEE
Last Name:TRANUM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KAGEN
Other - Middle Name:LEE
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:908 SHEA LN
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79706-7198
Mailing Address - Country:US
Mailing Address - Phone:432-413-2615
Mailing Address - Fax:
Practice Address - Street 1:850 TOWER DR STE 112
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4252
Practice Address - Country:US
Practice Address - Phone:432-614-0595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121281225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist