Provider Demographics
NPI:1497877781
Name:REYNOLDS, EMILY L (MS, OTR)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:L
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 W STATE ROAD 28
Mailing Address - Street 2:
Mailing Address - City:RIDGEVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47380-9256
Mailing Address - Country:US
Mailing Address - Phone:812-480-0654
Mailing Address - Fax:
Practice Address - Street 1:101 S MERIDIAN ST RM 209
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:IN
Practice Address - Zip Code:47371-2112
Practice Address - Country:US
Practice Address - Phone:812-480-0654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004354A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist