Provider Demographics
NPI:1376042374
Name:REYNOSO, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:REYNOSO
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 1:23770 BRIAR THISTLE LN
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-4546
Mailing Address - Country:US
Mailing Address - Phone:386-265-9708
Mailing Address - Fax:
Practice Address - Street 1:23770 BRIAR THISTLE LN
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-4546
Practice Address - Country:US
Practice Address - Phone:386-265-9708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant