Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1498 | SC |
NPI | 1023077302 |
---|---|
Provider Name | Mrs. Brenda Batten Reagan |
First Address | Awendaw, SC 29429-5914 |
Second Address | Awendaw, SC 29429-5914 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 19/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GP4022 | (05) | SC |
TH1465 | (05) | SC |