Provider Demographics
NPI:1740839018
Name:SEASTRUNK, REANA M (OTR/L)
Entity type:Individual
Prefix:
First Name:REANA
Middle Name:M
Last Name:SEASTRUNK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:REANA
Other - Middle Name:M
Other - Last Name:ACOSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 E CAMERON AVE APT B
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-7632
Mailing Address - Country:US
Mailing Address - Phone:310-966-0160
Mailing Address - Fax:
Practice Address - Street 1:204 E CAMERON AVE APT B
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-7632
Practice Address - Country:US
Practice Address - Phone:310-966-0160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13366225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist