MEDICARE: SAMUEL REEDER

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	OT011139	OH

General Provider Information

NPI Number	:	1770243461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL REEDER

Provider Business Mailing Address
First Line	:	808 SUNBURY RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-2551
Country	:	US
Telephone Number	:	614-905-6385
Fax Number	:

Provider Business Practice Location Address
First Line	:	3363 TREMONT RD
Second Line	:
City	:	UPPER ARLINGTON
State	:	OH
Zip	:	43221-2110
Country	:	US
Telephone Number	:	614-788-9242
Fax Number	:

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

Provider Enumeration Date	:	12/22/2021
Last Update Date	:	12/22/2021

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