Provider Demographics
NPI:1205232774
Name:REYNOLDS, CONNIE BELICZKY (MS-OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:BELICZKY
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MS-OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 VAUGHN RD
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-9253
Mailing Address - Country:US
Mailing Address - Phone:336-432-9533
Mailing Address - Fax:
Practice Address - Street 1:281 DOVE RD
Practice Address - Street 2:
Practice Address - City:RUFFIN
Practice Address - State:NC
Practice Address - Zip Code:27326-8936
Practice Address - Country:US
Practice Address - Phone:336-939-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8184225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist