Provider Demographics
NPI:1124126321
Name:REAVES, TWANNA A (OT)
Entity type:Individual
Prefix:
First Name:TWANNA
Middle Name:A
Last Name:REAVES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MATRIX CV
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1686
Mailing Address - Country:US
Mailing Address - Phone:731-736-0738
Mailing Address - Fax:
Practice Address - Street 1:15 MATRIX CV
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1686
Practice Address - Country:US
Practice Address - Phone:731-736-0738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2872225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist