Basic Information
| Provider Information | |||||||||
| NPI: | 1124174834 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAGENT | ||||||||
| FirstName: | CAROL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 810 4TH ST | ||||||||
| Address2: | |||||||||
| City: | BRILLIANT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439131110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7495984183 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 MEDICAL PARK | ||||||||
| Address2: | WHEELING HOSPITAL INC | ||||||||
| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042433124 | ||||||||
| FaxNumber: | 3042436343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | C1064 | WV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
ID Information
| ID | Type | State | Issuer | Description | OTA01820 | 01 | OH | OHIO LICENSE | OTHER |