Provider Demographics
NPI:1922368893
Name:HAGERMAN, GAIL
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:
Last Name:HAGERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:GAIL
Other - Middle Name:
Other - Last Name:CAMMIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:455 W WARREN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4038
Mailing Address - Country:US
Mailing Address - Phone:407-260-0551
Mailing Address - Fax:407-265-9590
Practice Address - Street 1:455 W WARREN AVE STE 200
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4038
Practice Address - Country:US
Practice Address - Phone:407-260-0551
Practice Address - Fax:407-265-9590
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT5304225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist