Healthcare Provider Details

I. General information

NPI: 1497559033
Provider Name (Legal Business Name): KENDAL TERESA REEVES OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 BRIARWOOD INDUSTRIAL CT NE STE A
BROOKHAVEN GA
30329-1642
US

IV. Provider business mailing address

1020 BRENTON DR NW
KENNESAW GA
30144-2770
US

V. Phone/Fax

Practice location:
  • Phone: 404-636-5272
  • Fax:
Mailing address:
  • Phone: 678-832-7242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT009463
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: