Provider Demographics
NPI:1801852330
Name:REAVES, CAROL T (OTR)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:T
Last Name:REAVES
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:PO BOX 2467
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-2467
Mailing Address - Country:US
Mailing Address - Phone:904-714-3976
Mailing Address - Fax:904-387-0156
Practice Address - Street 1:4101-1 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-5318
Practice Address - Country:US
Practice Address - Phone:904-387-0370
Practice Address - Fax:904-387-0156
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00003657225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics