Provider Demographics
NPI:1326757964
Name:HAGER, SHERRY (OT)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:
Last Name:HAGER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 PINE VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:MS
Mailing Address - Zip Code:39071-9655
Mailing Address - Country:US
Mailing Address - Phone:601-954-1549
Mailing Address - Fax:
Practice Address - Street 1:1904 LAKELAND DR STE D
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5038
Practice Address - Country:US
Practice Address - Phone:601-398-4164
Practice Address - Fax:769-216-3452
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1180225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist