Provider Demographics
NPI:1215644760
Name:HARDAGE, ANNA (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:HARDAGE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:GRACE
Other - Last Name:DUGGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:456 BRODRICK ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901
Mailing Address - Country:US
Mailing Address - Phone:501-428-3078
Mailing Address - Fax:
Practice Address - Street 1:456 BRODRICK ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-2930
Practice Address - Country:US
Practice Address - Phone:017-014-3485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3709225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR292317721Medicaid