Provider Demographics
NPI:1740764786
Name:HAGEN, ALEXA MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:MARIE
Last Name:HAGEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:MARIE
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:10825 WILLOWISP DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-3523
Mailing Address - Country:US
Mailing Address - Phone:402-350-8221
Mailing Address - Fax:
Practice Address - Street 1:8323 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1615
Practice Address - Country:US
Practice Address - Phone:713-772-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-15
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120394225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics