Provider Demographics
NPI:1437397429
Name:DENNISON, REAGAN DEANN (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:REAGAN
Middle Name:DEANN
Last Name:DENNISON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 APACHE DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-5904
Mailing Address - Country:US
Mailing Address - Phone:615-945-0601
Mailing Address - Fax:
Practice Address - Street 1:1905 W BEEBE CAPPS EXPY
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-5012
Practice Address - Country:US
Practice Address - Phone:501-268-5001
Practice Address - Fax:501-268-5443
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2212225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1749811721Medicaid