Provider Demographics
NPI:1972878163
Name:CRUMMEY, REAGAN MAE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:REAGAN
Middle Name:MAE
Last Name:CRUMMEY
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 1:8709 HIGHLAND RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-1654
Mailing Address - Country:US
Mailing Address - Phone:704-399-6451
Mailing Address - Fax:
Practice Address - Street 1:8709 HIGHLAND RIDGE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-1654
Practice Address - Country:US
Practice Address - Phone:704-399-6451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4181174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist