Provider Demographics
NPI:1790905453
Name:REYNOLDS, KELLY (OTR)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:REYNOLDS
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 1:310 E MORGANTON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-6524
Mailing Address - Country:US
Mailing Address - Phone:985-290-2179
Mailing Address - Fax:
Practice Address - Street 1:310 E MORGANTON RD
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-6524
Practice Address - Country:US
Practice Address - Phone:985-290-2179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist