Healthcare Provider Details

I. General information

NPI: 1780556829
Provider Name (Legal Business Name): MS. TERRI REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3608 EVANSVILLE AVE
DAYTON OH
45406-1509
US

IV. Provider business mailing address

3608 EVANSVILLE AVE
DAYTON OH
45406-1509
US

V. Phone/Fax

Practice location:
  • Phone: 937-251-6655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: