Provider Demographics
NPI:1417267931
Name:AREVALO, HAGEN STAFFORD (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:HAGEN
Middle Name:STAFFORD
Last Name:AREVALO
Suffix:
Gender:F
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 1:900 108TH AVE NE APT 510
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8605
Mailing Address - Country:US
Mailing Address - Phone:814-360-5816
Mailing Address - Fax:
Practice Address - Street 1:900 108TH AVE NE APT 510
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-8605
Practice Address - Country:US
Practice Address - Phone:814-360-5816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60629133225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist