Healthcare Provider Details

I. General information

NPI: 1356752265
Provider Name (Legal Business Name): FERREL MEARL REID JR. BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 01/05/2020
Certification Date: 01/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WOOD ST
EUREKA CA
95501-4413
US

IV. Provider business mailing address

1402 CLAM BEACH RD
MCKINLEYVILLE CA
95519-9487
US

V. Phone/Fax

Practice location:
  • Phone: 707-268-2990
  • Fax: 707-476-4061
Mailing address:
  • Phone: 707-267-4610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226000000X
TaxonomyRecreational Therapist Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: