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General NPI Number Information
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NPI Number | 1285147306
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Entity Type | Individual
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Provider Name | REAGAN LEANNE DRAKE ATC,LAT, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 11/11/2017
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 1282 UNION AVE
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City | MEMPHIS
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State | TN
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Zip | 38104-3414
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Country | US
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Telephone | 901-722-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 727 MANN CIR E APT 105
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City | MEMPHIS
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State | TN
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Zip | 38103-4536
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Country | US
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Telephone | 901-481-6114
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1453
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5699
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License Number State | TN
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