MEDICARE: CARISSA DAWN 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	224Z00000X	Occupational Therapy Assistant	16702	NC

General Provider Information

NPI Number	:	1578413530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARISSA DAWN REYNOLDS

Provider Business Mailing Address
First Line	:	404 MELODY LN
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28152-5145
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 W MARION ST
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-5338
Country	:	US
Telephone Number	:	704-476-8230
Fax Number	:

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

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	01/30/2026

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Directions to “ CARISSA DAWN REYNOLDS ” Practice Location

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