Provider Demographics
NPI:1568849271
Name:LEWELLEN, RICHARD REID (MT-BC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:REID
Last Name:LEWELLEN
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 TALAMORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655
Mailing Address - Country:US
Mailing Address - Phone:540-868-8103
Mailing Address - Fax:
Practice Address - Street 1:421 TALAMORE DRIVE
Practice Address - Street 2:
Practice Address - City:STEPHENS CITY
Practice Address - State:VA
Practice Address - Zip Code:22655
Practice Address - Country:US
Practice Address - Phone:540-868-8103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11197225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist