MEDICARE: HEATHER 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	235Z00000X	Speech-Language Pathologist	10808	NC

General Provider Information

NPI Number	:	1477966075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER REYNOLDS

Provider Business Mailing Address
First Line	:	105 FLORIDA AVE
Second Line	:
City	:	CAROLINA BEACH
State	:	NC
Zip	:	28428-5802
Country	:	US
Telephone Number	:	252-633-6770
Fax Number	:	877-335-6220

Provider Business Practice Location Address
First Line	:	105 FLORIDA AVE
Second Line	:
City	:	CAROLINA BEACH
State	:	NC
Zip	:	28428-5802
Country	:	US
Telephone Number	:	252-633-6770
Fax Number	:	877-335-6220

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

Provider Enumeration Date	:	06/11/2014
Last Update Date	:	03/26/2019

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Directions to “ HEATHER REYNOLDS ” Practice Location

Language	Start Address	Practice Location

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