Provider Demographics
NPI:1225506512
Name:REEDER, JESSICA KATE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KATE
Last Name:REEDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13412 KINGRAIL WAY
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-8755
Mailing Address - Country:US
Mailing Address - Phone:317-443-9633
Mailing Address - Fax:
Practice Address - Street 1:13412 KINGRAIL WAY
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-8755
Practice Address - Country:US
Practice Address - Phone:317-443-9633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist