Provider Demographics
NPI:1477972784
Name:HAGEN, TESSA NICOLE (MOT, OTR/L)
Entity type:Individual
Prefix:MISS
First Name:TESSA
Middle Name:NICOLE
Last Name:HAGEN
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:KINDRED
Mailing Address - State:ND
Mailing Address - Zip Code:58051-4027
Mailing Address - Country:US
Mailing Address - Phone:701-641-0416
Mailing Address - Fax:
Practice Address - Street 1:55 1ST AVE S
Practice Address - Street 2:
Practice Address - City:KINDRED
Practice Address - State:ND
Practice Address - Zip Code:58051-4027
Practice Address - Country:US
Practice Address - Phone:701-641-0416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1188225XP0200X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics