Provider Demographics
NPI:1154078277
Name:REID, KEVIN BRUCE
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:BRUCE
Last Name:REID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 JOHN MUNN RD
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-1341
Mailing Address - Country:US
Mailing Address - Phone:518-354-5390
Mailing Address - Fax:
Practice Address - Street 1:50 JOHN MUNN RD
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-1341
Practice Address - Country:US
Practice Address - Phone:518-354-5390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor