Healthcare Provider Details

I. General information

NPI: 1225868359
Provider Name (Legal Business Name): CHELSEA HARRA REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S STATE RD STE 220
SPRINGFIELD PA
19064-1243
US

IV. Provider business mailing address

2617 S 17TH ST
PHILADELPHIA PA
19145-4501
US

V. Phone/Fax

Practice location:
  • Phone: 610-356-1991
  • Fax:
Mailing address:
  • Phone: 267-251-9249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: