MEDICARE: KEVIN REYES

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	029853	NY

General Provider Information

NPI Number	:	1356150379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN REYES

Provider Business Mailing Address
First Line	:	425 ARIZONA AVE
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-2313
Country	:	US
Telephone Number	:	631-885-5267
Fax Number	:

Provider Business Practice Location Address
First Line	:	868 CHURCH ST
Second Line	:
City	:	BOHEMIA
State	:	NY
Zip	:	11716-5021
Country	:	US
Telephone Number	:	631-676-4185
Fax Number	:

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

Provider Enumeration Date	:	01/03/2025
Last Update Date	:	01/06/2025

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Directions to “ KEVIN REYES ” Practice Location

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