Provider Demographics
NPI:1407082654
Name:HAGER, KIRSTIN A (OTR L)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTIN
Middle Name:A
Last Name:HAGER
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:MS
Other - First Name:KIRSTIN
Other - Middle Name:ANNETTE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR L
Mailing Address - Street 1:161 TIE MILL RD
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-8757
Mailing Address - Country:US
Mailing Address - Phone:417-753-9434
Mailing Address - Fax:
Practice Address - Street 1:161 TIE MILL RD
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65742-8757
Practice Address - Country:US
Practice Address - Phone:417-753-9434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004731225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist