Provider Demographics
NPI:1164180394
Name:KORN-REAVIS, AMY MICHELE (RRT, CCHS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELE
Last Name:KORN-REAVIS
Suffix:
Gender:F
Credentials:RRT, CCHS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MICHELE
Other - Last Name:MENSAKC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT
Mailing Address - Street 1:9573 TURKEY OAK BND
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-2743
Mailing Address - Country:US
Mailing Address - Phone:407-517-8129
Mailing Address - Fax:
Practice Address - Street 1:9573 TURKEY OAK BND
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-2743
Practice Address - Country:US
Practice Address - Phone:407-517-8129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-05
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT124702278E1000X, 2278G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care
No2278E1000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedEducational