Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 46TR00320400 | NJ |
NPI | 1053519652 |
---|---|
Provider Name | Mrs. Carla G. Hagan |
First Address | New Hope, PA 18938-9685 |
Second Address | Hamilton, NJ 08619-1205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2007 |
Last Update Date | 08/07/2007 |