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General NPI Number Information
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NPI Number | 1720465198
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Entity Type | Individual
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Provider Name | ELIZABETH VIRGINIA REYNOLDS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/05/2015
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Last Update Date | 02/24/2020
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Provider Practice Location Address
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Address Line | 4603 TIMBERWALK CT
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City | LA GRANGE
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State | KY
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Zip | 40031-6746
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Country | US
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Telephone | 606-776-0071
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Fax |
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Provider Business Mailing Address
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Address Line | 710 DEER RUN LN
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City | MOREHEAD
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State | KY
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Zip | 40351-7912
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Country | US
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Telephone | 606-776-0071
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT.008456
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | BOTOCT00218425
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License Number State | KY
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