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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Sunday, April 28, 2024 6:57 PM CDT
Next Update: Monday, April 29, 2024 2:50 AM CDT

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HAGEBUSCH, NICHOLAS JERAD
Practice Address: ELEVATE PEDIATRIC THERAPIES
1110 W WILL ROGERS BLVD
CLAREMORE OK 74017

Address last updated on 12/31/2023
Phone #: (918) 341-4343
Fax #:
County: ROGERS
License: 3725
Dated: 9/1/2023
Expires: 1/31/2025
Temp. Ltr. Issued: 8/15/2023
Temp. Ltr. Expires: 9/14/2023
License Type: Physical Therapist Assistant
Specialty:
Status: Active
Status Class: Fully Licensed
Restricted to:
CME Year: 2026
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Locations: Hours: Languages:
ELEVATE PEDIATRIC THERAPIES
1110 W WILL ROGERS BLVD
CLAREMORE OK 74017

Phone #: (918) 341-4343
Fax #:
Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
RANDYE NICHOLE DIXON PT 5814
CAROLINE A WAGNER PT 6149

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