Provider Demographics
NPI:1942953237
Name:SHACKELFORD, RAEGAN CHRISTINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:RAEGAN
Middle Name:CHRISTINE
Last Name:SHACKELFORD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 SHACKLEFORD LN
Mailing Address - Street 2:
Mailing Address - City:AUTAUGAVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36003-3005
Mailing Address - Country:US
Mailing Address - Phone:334-544-9964
Mailing Address - Fax:
Practice Address - Street 1:340 MENDEL PKWY W
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-5406
Practice Address - Country:US
Practice Address - Phone:334-532-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5748225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics