Provider Demographics
NPI:1821584699
Name:HAGEN, ADRIENNE MARIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:MARIE
Last Name:HAGEN
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 1:1475 KISKER RD STE 150
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-8789
Mailing Address - Country:US
Mailing Address - Phone:317-727-7540
Mailing Address - Fax:
Practice Address - Street 1:1475 KISKER RD STE 150
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-8789
Practice Address - Country:US
Practice Address - Phone:317-727-7540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018014561225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty