Provider Demographics
NPI:1275398208
Name:REYNOLDS, GABRIELLE RAE (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:RAE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7870 W US HIGHWAY 290 APT 3205
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78736-1843
Mailing Address - Country:US
Mailing Address - Phone:225-333-2962
Mailing Address - Fax:
Practice Address - Street 1:3809 S 2ND ST STE D200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7191
Practice Address - Country:US
Practice Address - Phone:512-441-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124336225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist