Provider Demographics
NPI:1275740631
Name:HAGLE, HARLAN OSCAR (COTA)
Entity Type:Individual
Prefix:MR
First Name:HARLAN
Middle Name:OSCAR
Last Name:HAGLE
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 AMELIA CT APT 1012
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6123
Mailing Address - Country:US
Mailing Address - Phone:469-467-6838
Mailing Address - Fax:
Practice Address - Street 1:8615 FREEPORT PKWY
Practice Address - Street 2:225
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2576
Practice Address - Country:US
Practice Address - Phone:972-812-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207868224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant