Individual
MRS. HAILEY DAWN HAGENESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.O.T., OTR/L
Contact information
Practice address
1235 S 24TH ST, ATTN REHABCARE, MANITOWOC, WI 54220-5516
(920) 682-8254
Mailing address
2121 45TH ST, UNIT F, TWO RIVERS, WI 54241-1172
(989) 621-5197
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4872-26
WI
Other
Enumeration date
05/06/2010
Last updated
05/06/2010
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