MEDICARE: MRS. CONNIE BELICZKY REYNOLDS MS-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	8184	NC

General Provider Information

NPI Number	:	1205232774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CONNIE BELICZKY REYNOLDS MS-OTR/L

Provider Business Mailing Address
First Line	:	121 VAUGHN RD
Second Line	:
City	:	REIDSVILLE
State	:	NC
Zip	:	27320-9253
Country	:	US
Telephone Number	:	336-432-9533
Fax Number	:

Provider Business Practice Location Address
First Line	:	281 DOVE RD
Second Line	:
City	:	RUFFIN
State	:	NC
Zip	:	27326-8936
Country	:	US
Telephone Number	:	336-939-3312
Fax Number	:

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

Provider Enumeration Date	:	11/11/2014
Last Update Date	:	11/11/2014

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