Provider Demographics
NPI:1144588179
Name:REYNOLDS, TYNISHA MONEAK (COTA)
Entity Type:Individual
Prefix:
First Name:TYNISHA
Middle Name:MONEAK
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 QUALITY DR
Mailing Address - Street 2:APT. F10
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-8372
Mailing Address - Country:US
Mailing Address - Phone:501-268-5001
Mailing Address - Fax:501-268-5443
Practice Address - Street 1:2501 E MOORE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4751
Practice Address - Country:US
Practice Address - Phone:501-268-5001
Practice Address - Fax:501-268-5443
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT1203224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant