MEDICARE: MRS. SHEILA DENNEY REAGAN 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	OT001493	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518191808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHEILA DENNEY REAGAN OTR/L

Provider Business Mailing Address
First Line	:	2515 OAK GROVE CHURCH RD
Second Line	:
City	:	CARROLLTON
State	:	GA
Zip	:	30117-9525
Country	:	US
Telephone Number	:	770-755-8033
Fax Number	:

Provider Business Practice Location Address
First Line	:	2515 OAK GROVE CHURCH RD
Second Line	:
City	:	CARROLLTON
State	:	GA
Zip	:	30117-9525
Country	:	US
Telephone Number	:	770-755-8033
Fax Number	:

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

Provider Enumeration Date	:	05/14/2009
Last Update Date	:	08/20/2016

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