Provider Demographics
NPI:1457061566
Name:REYNOLDS, ROSLYN
Entity Type:Individual
Prefix:
First Name:ROSLYN
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 1:191 HAMLIN FORD RD
Mailing Address - Street 2:
Mailing Address - City:STONEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27048-8612
Mailing Address - Country:US
Mailing Address - Phone:336-427-2508
Mailing Address - Fax:
Practice Address - Street 1:191 HAMLIN FORD RD
Practice Address - Street 2:
Practice Address - City:STONEVILLE
Practice Address - State:NC
Practice Address - Zip Code:27048-8612
Practice Address - Country:US
Practice Address - Phone:336-427-2508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist