Healthcare Provider Details

I. General information

NPI: 1487563466
Provider Name (Legal Business Name): MADISON REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 N CHEMUNG ST
WAVERLY NY
14892-1211
US

IV. Provider business mailing address

209 ONEIDA PL
CORNING NY
14830-1407
US

V. Phone/Fax

Practice location:
  • Phone: 607-565-2861
  • Fax:
Mailing address:
  • Phone: 607-426-6566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number029616
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: