Provider Demographics
NPI:1003130337
Name:REYNOLDS, KIMBERLY RAE (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:RAE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:RAE
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:7520 W UNIVERSITY AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-7611
Mailing Address - Country:US
Mailing Address - Phone:352-505-6339
Mailing Address - Fax:352-505-6340
Practice Address - Street 1:7520 W UNIVERSITY AVE
Practice Address - Street 2:SUITE D
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-7611
Practice Address - Country:US
Practice Address - Phone:352-505-6339
Practice Address - Fax:352-505-6340
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13038225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist