Provider Demographics
NPI:1043335110
Name:HAGE, PENNY S (OTLR)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:S
Last Name:HAGE
Suffix:
Gender:F
Credentials:OTLR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4328 BLAND RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6125
Mailing Address - Country:US
Mailing Address - Phone:919-341-3894
Mailing Address - Fax:
Practice Address - Street 1:4328 BLAND RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6125
Practice Address - Country:US
Practice Address - Phone:919-341-3894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2350225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist