Provider Demographics
NPI:1285147306
Name:DRAKE, REAGAN LEANNE (ATC,LAT, OTR/L)
Entity type:Individual
Prefix:MS
First Name:REAGAN
Middle Name:LEANNE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:ATC,LAT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 MANN CIR E APT 105
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-4536
Mailing Address - Country:US
Mailing Address - Phone:901-481-6114
Mailing Address - Fax:
Practice Address - Street 1:1282 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3414
Practice Address - Country:US
Practice Address - Phone:901-722-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14532255A2300X
TN5699225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer