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General NPI Number Information
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NPI Number | 1235266594
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Entity Type | Individual
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Provider Name | TODD ALLEN HAGBERG OTR
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Gender | Male
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/24/2015
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Provider Practice Location Address
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Address Line | 3655 S BALDWIN RD
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City | ORION
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State | MI
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Zip | 48359-1506
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Country | US
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Telephone | 248-393-1699
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Fax |
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Provider Business Mailing Address
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Address Line | 820 N BALDWIN RD
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City | OXFORD
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State | MI
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Zip | 48371-3418
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Country | US
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Telephone | 248-969-6965
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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