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General NPI Number Information
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NPI Number | 1386116788
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Entity Type | Individual
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Provider Name | MADELINE MICHELLE HAGER
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Gender | Female
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Dates
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Enumeration Date | 12/23/2018
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Last Update Date | 12/23/2018
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Provider Practice Location Address
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Address Line | 2012 E NIFONG BLVD
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City | COLUMBIA
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State | MO
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Zip | 65201-3874
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Country | US
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Telephone | 573-449-1246
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Fax |
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Provider Business Mailing Address
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Address Line | 213 COLLEGE AVE
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City | MOBERLY
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State | MO
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Zip | 65270-1481
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Country | US
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Telephone |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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