Individual
LAURA B HAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
10020 PROFESSIONAL CENTER DR., SUITE 100, HAMBURG, MI 48139
(810) 231-6904
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
2485
CO
225X00000X
Occupational Therapist
Primary
5201004245
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2485
LICENSE
CO
01
—
P01437456
RR MEDICARE
MI
Enumeration date
11/02/2006
Last updated
05/08/2015
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