Provider Demographics
NPI:1689655763
Name:REED, DARRELL EDWARD (ATC)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:EDWARD
Last Name:REED
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5794 NEARING CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-1937
Mailing Address - Country:US
Mailing Address - Phone:440-257-3309
Mailing Address - Fax:866-235-6923
Practice Address - Street 1:4480 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5777
Practice Address - Country:US
Practice Address - Phone:216-595-2880
Practice Address - Fax:216-595-2879
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0003272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer