MEDICARE: MS. RITA REYNOLDS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.166501	OH
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1073028288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RITA REYNOLDS

Provider Business Mailing Address
First Line	:	PO BOX 8189
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-0189
Country	:	US
Telephone Number	:	330-867-5400
Fax Number	:	330-996-4959

Provider Business Practice Location Address
First Line	:	1221 E WATERLOO RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44306-3805
Country	:	US
Telephone Number	:	234-708-4184
Fax Number	:	330-869-8263

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

Provider Enumeration Date	:	12/11/2017
Last Update Date	:	02/27/2019

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