Provider Demographics
NPI:1316141229
Name:REED, NITA REAGON (OTR)
Entity type:Individual
Prefix:MS
First Name:NITA
Middle Name:REAGON
Last Name:REED
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 BILGLADE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-1616
Mailing Address - Country:US
Mailing Address - Phone:817-886-8976
Mailing Address - Fax:817-923-1263
Practice Address - Street 1:901 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2226
Practice Address - Country:US
Practice Address - Phone:817-348-9711
Practice Address - Fax:817-348-9809
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104311225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist