Provider Demographics
NPI:1780317685
Name:REESE, SAVANNAH L (COTA/L)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:L
Last Name:REESE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 E WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-1247
Mailing Address - Country:US
Mailing Address - Phone:316-734-6520
Mailing Address - Fax:
Practice Address - Street 1:228 E WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-1247
Practice Address - Country:US
Practice Address - Phone:316-734-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-01435224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty