Provider Demographics
NPI:1669673513
Name:GIELINCKI, REAGAN FRANCES (MS, OTR, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:REAGAN
Middle Name:FRANCES
Last Name:GIELINCKI
Suffix:
Gender:F
Credentials:MS, OTR, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-9095
Mailing Address - Country:US
Mailing Address - Phone:801-388-1640
Mailing Address - Fax:
Practice Address - Street 1:410 N PATTERSON RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-9095
Practice Address - Country:US
Practice Address - Phone:801-388-1640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1056441225X00000X
174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist