Provider Demographics
NPI:1962032300
Name:REYNOLDS, NORKA
Entity Type:Individual
Prefix:
First Name:NORKA
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11222 BLACK BRANT LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-6967
Mailing Address - Country:US
Mailing Address - Phone:954-600-0022
Mailing Address - Fax:
Practice Address - Street 1:1038 SHORTHILL LN
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-0170
Practice Address - Country:US
Practice Address - Phone:803-869-0077
Practice Address - Fax:803-228-0101
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7429225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist