Provider Demographics
NPI:1972996270
Name:HAGEN, KATHLEEN (OT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:HAGEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S 336TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7354
Mailing Address - Country:US
Mailing Address - Phone:866-835-8091
Mailing Address - Fax:888-835-7102
Practice Address - Street 1:1010 S 336TH ST STE 210
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7354
Practice Address - Country:US
Practice Address - Phone:866-835-8091
Practice Address - Fax:888-835-7102
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 60475838225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist