Provider Demographics
NPI:1942323076
Name:REYNOLDS, KIMBERLY J (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:J
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 1:51-55 NORTH ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:W. HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10993
Mailing Address - Country:US
Mailing Address - Phone:845-786-4000
Mailing Address - Fax:845-786-4068
Practice Address - Street 1:51-55 NORTH ROUTE 9W
Practice Address - Street 2:
Practice Address - City:W. HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993
Practice Address - Country:US
Practice Address - Phone:845-786-4000
Practice Address - Fax:845-786-4068
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation