Provider Demographics
NPI:1336476902
Name:MCDONALD, RAGENA RENEE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:RAGENA
Middle Name:RENEE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5150 STILESBORO RD NW STE 430
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7759
Mailing Address - Country:US
Mailing Address - Phone:770-218-2300
Mailing Address - Fax:770-218-2201
Practice Address - Street 1:5150 STILESBORO RD NW STE 430
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7759
Practice Address - Country:US
Practice Address - Phone:770-218-2300
Practice Address - Fax:770-218-2201
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003154225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist