MEDICARE: MRS. REGAN LEIGH HAGGERTY MS, 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	225X00000X	Occupational Therapist	OT-4418	OH

General Provider Information

NPI Number	:	1295402279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REGAN LEIGH HAGGERTY MS, OTR/L

Provider Business Mailing Address
First Line	:	10092 GRANDEN ST
Second Line	:
City	:	PICKERINGTON
State	:	OH
Zip	:	43147-9768
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	363 BRAUN PL
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-7796
Country	:	US
Telephone Number	:	614-810-7107
Fax Number	:

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

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	08/26/2021

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