Provider Demographics
NPI:1346020773
Name:HAGEN, ROBERT EDWARD (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EDWARD
Last Name:HAGEN
Suffix:
Gender:M
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 1:1880 BRONSON STREET
Mailing Address - Street 2:
Mailing Address - City:PENINSULA
Mailing Address - State:OH
Mailing Address - Zip Code:44264-9602
Mailing Address - Country:US
Mailing Address - Phone:216-570-1616
Mailing Address - Fax:
Practice Address - Street 1:85 3RD ST SE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4208
Practice Address - Country:US
Practice Address - Phone:330-753-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6313225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist