Provider Demographics
NPI:1104131887
Name:HAGELE, CHRISTINA ROSE I (COTA)
Entity type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:ROSE
Last Name:HAGELE
Suffix:I
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 S CHURCH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-2559
Mailing Address - Country:US
Mailing Address - Phone:608-617-2459
Mailing Address - Fax:
Practice Address - Street 1:416 S CHURCH ST APT 3
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-2559
Practice Address - Country:US
Practice Address - Phone:608-617-2459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4773-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant