Provider Demographics
NPI:1770647562
Name:REESE, CYNTHIA BERNADETTE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:BERNADETTE
Last Name:REESE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 HUNTERS HILL CT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-8647
Mailing Address - Country:US
Mailing Address - Phone:478-475-5868
Mailing Address - Fax:
Practice Address - Street 1:221 HUNTERS HILL CT
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-8647
Practice Address - Country:US
Practice Address - Phone:478-475-5868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000282225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00864322DMedicaid