=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750788170
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENNA REYNOLDS MS, OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2014
-----------------------------------------------------
Last Update Date | 06/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1040 MARKET ST
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42420-4855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-827-4652
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 51322
-----------------------------------------------------
City | BOWLING GREEN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42102-5622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-202-5157
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172V00000X
-----------------------------------------------------
Taxonomy Name | Community Health Worker
-----------------------------------------------------
License Number | BOTOCT00209249
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------