MEDICARE: DR. REAGAN MAYBERRY OTD, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1023844131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REAGAN MAYBERRY OTD, OTR/L

Provider Business Mailing Address
First Line	:	4403 W 4TH ST
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-1006
Country	:	US
Telephone Number	:	601-325-0216
Fax Number	:

Provider Business Practice Location Address
First Line	:	4403 W 4TH ST STE E
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-1006
Country	:	US
Telephone Number	:	601-325-0216
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2024
Last Update Date	:	05/30/2026

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Directions to “ DR. REAGAN MAYBERRY OTD, OTR/L” Practice Location

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