Provider Demographics
NPI:1013226224
Name:REYNOLDS, JESSICA LYNN (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT MARION
Mailing Address - State:NY
Mailing Address - Zip Code:12456
Mailing Address - Country:US
Mailing Address - Phone:845-430-4831
Mailing Address - Fax:
Practice Address - Street 1:56 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MOUNT MARION
Practice Address - State:NY
Practice Address - Zip Code:12456
Practice Address - Country:US
Practice Address - Phone:845-430-4831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2924225X00000X
NY016005225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist