1023332061 NPI number — TRENISE SAVERIN REED OT

Table of content: TRENISE SAVERIN REED OT (NPI 1023332061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023332061 NPI number — TRENISE SAVERIN REED OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REED
Provider First Name:
TRENISE
Provider Middle Name:
SAVERIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAVERIN
Provider Other First Name:
TRENISE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023332061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 E COUNTY LINE RD
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
RIDGELAND
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39157-1928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-853-8747
Provider Business Mailing Address Fax Number:
601-898-4761

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
950 E COUNTY LINE RD
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
RIDGELAND
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39157-1928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-853-8747
Provider Business Practice Location Address Fax Number:
601-898-4761
Provider Enumeration Date:
03/19/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OTT.200237 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: OT2679 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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