Individual
TAHNEE DYANNE HAGENBUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
634 N MAIN ST, SUITE 5, O FALLON, IL 62269-3746
(618) 690-0068
(888) 452-2930
Mailing address
634 N MAIN ST, SUITE 5, O FALLON, IL 62269-3746
(618) 690-0068
(888) 452-2930
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
056009118
IL
Other
Enumeration date
12/19/2012
Last updated
12/19/2012
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