Provider Demographics
NPI:1447091665
Name:HARVEY, REAGAN ANN (LMT)
Entity type:Individual
Prefix:
First Name:REAGAN
Middle Name:ANN
Last Name:HARVEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:REAGAN
Other - Middle Name:ANN
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:146 CONNOLLY ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 COLEMANS CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-7068
Practice Address - Country:US
Practice Address - Phone:937-738-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.026825225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist