Provider Demographics
NPI:1255618310
Name:REIS-HENRIE, FABIOLA PINTO (OTR)
Entity type:Individual
Prefix:MRS
First Name:FABIOLA
Middle Name:PINTO
Last Name:REIS-HENRIE
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 1:7914 RYCKERT ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-2808
Mailing Address - Country:US
Mailing Address - Phone:913-219-2423
Mailing Address - Fax:
Practice Address - Street 1:7850 FREEMAN AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-2133
Practice Address - Country:US
Practice Address - Phone:913-334-3666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1702541225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist