MEDICARE: MS. TONI SUE REISS

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1992866099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TONI SUE REISS

Provider Business Mailing Address
First Line	:	2116 LAKESIDE DRIVE
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40502-3019
Country	:	US
Telephone Number	:	859-269-1409
Fax Number	:	859-269-7347

Provider Business Practice Location Address
First Line	:	2116 LAKESIDE DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40502-3019
Country	:	US
Telephone Number	:	859-269-1409
Fax Number	:	859-269-7347

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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