Provider Demographics
NPI:1366036758
Name:REED, RUTH VERONICA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:VERONICA
Last Name:REED
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:RUTH
Other - Middle Name:VERONICA
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1013 RIDGEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-6631
Mailing Address - Country:US
Mailing Address - Phone:904-651-1464
Mailing Address - Fax:
Practice Address - Street 1:2020 W LAKE PARKER DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-5005
Practice Address - Country:US
Practice Address - Phone:863-682-7580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT21475225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist