Provider Demographics
NPI:1013162890
Name:HAGEMEYER, PAULA E (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:E
Last Name:HAGEMEYER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:PAULINE
Other - Middle Name:EVELYN
Other - Last Name:HAGEMEYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:14491 N THORP HWY
Mailing Address - Street 2:
Mailing Address - City:THORP
Mailing Address - State:WA
Mailing Address - Zip Code:98946-9554
Mailing Address - Country:US
Mailing Address - Phone:509-964-2086
Mailing Address - Fax:
Practice Address - Street 1:14491 N THORP HWY
Practice Address - Street 2:
Practice Address - City:THORP
Practice Address - State:WA
Practice Address - Zip Code:98946-9554
Practice Address - Country:US
Practice Address - Phone:509-964-2086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002937172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8852669Medicare PIN