MEDICARE: KAYCE BOCK REYNOLDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	PO21411	NC

General Provider Information

NPI Number	:	1497574081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYCE BOCK REYNOLDS

Provider Business Mailing Address
First Line	:	PO BOX 149
Second Line	:
City	:	PAW CREEK
State	:	NC
Zip	:	28130-0149
Country	:	US
Telephone Number	:	704-606-1162
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 SUNSET RD UNIT 681753
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-0480
Country	:	US
Telephone Number	:	980-288-5282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	10/09/2024

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