Provider Demographics
NPI:1558541201
Name:HAGWOOD, ELEANOR E (MED, CAGS)
Entity Type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:E
Last Name:HAGWOOD
Suffix:
Gender:F
Credentials:MED, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 BETTY SPRING RD
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-2411
Mailing Address - Country:US
Mailing Address - Phone:978-632-6636
Mailing Address - Fax:
Practice Address - Street 1:339 BETTY SPRING RD
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-2411
Practice Address - Country:US
Practice Address - Phone:978-632-6636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-10
Last Update Date:2007-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA164534222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist