MEDICARE: JESSICA LYNN REYNOLDS M.S. OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	2924	CO
2	225X00000X	Occupational Therapist	016005	NY

General Provider Information

NPI Number	:	1013226224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LYNN REYNOLDS M.S. OTR/L

Provider Business Mailing Address
First Line	:	56 COUNTRY CLUB DR
Second Line	:
City	:	MOUNT MARION
State	:	NY
Zip	:	12456
Country	:	US
Telephone Number	:	845-430-4831
Fax Number	:

Provider Business Practice Location Address
First Line	:	56 COUNTRY CLUB DR
Second Line	:
City	:	MOUNT MARION
State	:	NY
Zip	:	12456
Country	:	US
Telephone Number	:	845-430-4831
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2010
Last Update Date	:	09/07/2012

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