Provider Demographics
NPI:1407443484
Name:HINSLEY, REAGAN PARKER (COTA/L)
Entity Type:Individual
Prefix:
First Name:REAGAN
Middle Name:PARKER
Last Name:HINSLEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 LAKE POINT LN
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-2077
Mailing Address - Country:US
Mailing Address - Phone:870-378-5709
Mailing Address - Fax:
Practice Address - Street 1:8477 NORTH ST
Practice Address - Street 2:
Practice Address - City:BIRCH TREE
Practice Address - State:MO
Practice Address - Zip Code:65438-8887
Practice Address - Country:US
Practice Address - Phone:417-372-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-24
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant