Provider Demographics
NPI:1922704212
Name:REYNOLDS, KAYLYN MARIE
Entity Type:Individual
Prefix:
First Name:KAYLYN
Middle Name:MARIE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLYN
Other - Middle Name:MARIE
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:98-820 MOANALUA RD SPC 5
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5200
Mailing Address - Country:US
Mailing Address - Phone:808-845-6080
Mailing Address - Fax:
Practice Address - Street 1:98-820 MOANALUA RD SPC 5
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5200
Practice Address - Country:US
Practice Address - Phone:808-845-6080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician