Healthcare Provider Details

I. General information

NPI: 1811806607
Provider Name (Legal Business Name): REAGAN MEMMER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 65TH AVE
OSCEOLA WI
54020-4376
US

IV. Provider business mailing address

2376 10TH AVE
OSCEOLA WI
54020-5916
US

V. Phone/Fax

Practice location:
  • Phone: 715-294-2111
  • Fax:
Mailing address:
  • Phone: 612-240-9138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number105908
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: