Individual
JESSICA HAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA0000001973
TN
Other
Enumeration date
05/19/2011
Last updated
05/19/2011
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