Provider Demographics
NPI:1669441002
Name:REYNOLDS, JEFFREY J (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:J
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 ARNOLD DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010-2367
Mailing Address - Country:US
Mailing Address - Phone:316-775-5645
Mailing Address - Fax:316-804-6265
Practice Address - Street 1:NEWTON MEDICAL CENTER
Practice Address - Street 2:600 MEDICAL CENTER DR
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-0308
Practice Address - Country:US
Practice Address - Phone:316-804-6080
Practice Address - Fax:316-804-6265
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01095225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist