Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 1064233 | OR |
NPI | 1184045478 |
---|---|
Provider Name | Leslie Reagan |
First Address | White Salmon, WA 98672-0550 |
Second Address | The Dalles, OR 97058-3317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2014 |
Last Update Date | 03/01/2014 |