MEDICARE: SAMANTHA HAGGE OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	1895	NE
2	225X00000X	Occupational Therapist	1895	NE

General Provider Information

NPI Number	:	1346549474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA HAGGE OT

Provider Business Mailing Address
First Line	:	10601 S 72ND ST
Second Line	:	STE. 103
City	:	PAPILLION
State	:	NE
Zip	:	68046-3407
Country	:	US
Telephone Number	:	402-932-2782
Fax Number	:	402-932-2705

Provider Business Practice Location Address
First Line	:	10601 S 72ND ST
Second Line	:	STE. 103
City	:	PAPILLION
State	:	NE
Zip	:	68046-3407
Country	:	US
Telephone Number	:	402-932-2782
Fax Number	:	402-932-2705

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2011
Last Update Date	:	07/30/2015

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Directions to “ SAMANTHA HAGGE OT” Practice Location

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