Provider Demographics
NPI:1639325582
Name:HAGSTROM, LORINDA LEE (OTR)
Entity Type:Individual
Prefix:MS
First Name:LORINDA
Middle Name:LEE
Last Name:HAGSTROM
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 SE INTERNATIONAL WAY, SUITE 100
Mailing Address - Street 2:CONSONUS HEALTHCARE SERVICES
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222
Mailing Address - Country:US
Mailing Address - Phone:971-206-5167
Mailing Address - Fax:971-206-5209
Practice Address - Street 1:1417 116TH AVE NE STE 110
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3821
Practice Address - Country:US
Practice Address - Phone:425-688-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002045225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist