Provider Demographics
NPI:1689016420
Name:REEDY, JOHN F (MS OTR/L)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:F
Last Name:REEDY
Suffix:
Gender:M
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 DEVONSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1946
Mailing Address - Country:US
Mailing Address - Phone:716-913-5609
Mailing Address - Fax:
Practice Address - Street 1:107 DEVONSHIRE RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-1946
Practice Address - Country:US
Practice Address - Phone:716-913-5609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003648225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0003648OtherOCCUPATIONAL THERAPY REGISTRATION
NY018121OtherOCCUPATIONAL THERAPY LICENSURE