Provider Demographics
NPI:1033605308
Name:REYES, SPENCER (OTR/L)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 MADRID AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-1921
Mailing Address - Country:US
Mailing Address - Phone:321-412-2044
Mailing Address - Fax:
Practice Address - Street 1:35 PARRIS ISLAND GTWY UNIT 198
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-4244
Practice Address - Country:US
Practice Address - Phone:843-575-4722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6117225X00000X
FLOT18299225X00000X
SC10045225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist