Provider Demographics
NPI:1376886051
Name:REYNAGA, GLORIA ARACELI (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:ARACELI
Last Name:REYNAGA
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1957 E DIAMOND AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-3629
Mailing Address - Country:US
Mailing Address - Phone:907-887-1075
Mailing Address - Fax:
Practice Address - Street 1:1957 E DIAMOND AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-3629
Practice Address - Country:US
Practice Address - Phone:907-887-1075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7136225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist