Provider Demographics
NPI:1134806029
Name:REYNOLDS, MICHALA DANIELLE (MA)
Entity type:Individual
Prefix:
First Name:MICHALA
Middle Name:DANIELLE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1283 LAMAR ST APT 9
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-3422
Mailing Address - Country:US
Mailing Address - Phone:303-419-9396
Mailing Address - Fax:
Practice Address - Street 1:1283 LAMAR ST APT 9
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-3422
Practice Address - Country:US
Practice Address - Phone:303-419-9396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist