Healthcare Provider Details

I. General information

NPI: 1063162923
Provider Name (Legal Business Name): TORI REAGAN SEVERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 S MAIN ST STE 200
CENTERVILLE OH
45458-4358
US

IV. Provider business mailing address

1023 S MAIN ST STE 200
CENTERVILLE OH
45458-4358
US

V. Phone/Fax

Practice location:
  • Phone: 937-436-3117
  • Fax: 937-436-0730
Mailing address:
  • Phone: 937-436-3117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.153359
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: