MEDICARE: MS. MELISSA JOY REYNOLDS BEHAVIORAL INTERVENT

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1336872399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA JOY REYNOLDS BEHAVIORAL INTERVENT

Provider Business Mailing Address
First Line	:	500 FAIRWAY DR STE 102
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-1817
Country	:	US
Telephone Number	:	354-347-3736
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 FAIRWAY DR STE 101
Second Line	:
City	:	DEERFIELD BCH
State	:	FL
Zip	:	33441-1819
Country	:	US
Telephone Number	:	954-947-3637
Fax Number	:

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

Provider Enumeration Date	:	07/07/2022
Last Update Date	:	07/07/2022

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