Provider Demographics
NPI:1023077302
Name:REAGAN, BRENDA BATTEN (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:BATTEN
Last Name:REAGAN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 EDEN RD
Mailing Address - Street 2:
Mailing Address - City:AWENDAW
Mailing Address - State:SC
Mailing Address - Zip Code:29429-5914
Mailing Address - Country:US
Mailing Address - Phone:843-270-3567
Mailing Address - Fax:843-856-4932
Practice Address - Street 1:1320 EDEN RD
Practice Address - Street 2:
Practice Address - City:AWENDAW
Practice Address - State:SC
Practice Address - Zip Code:29429-5914
Practice Address - Country:US
Practice Address - Phone:843-270-3567
Practice Address - Fax:843-856-4932
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1498225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4022Medicaid
SCTH1465Medicaid