Provider Demographics
NPI:1508609314
Name:REEL, KEVIN DAVID
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:DAVID
Last Name:REEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 E WASHINGTON ST APT B
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-2818
Mailing Address - Country:US
Mailing Address - Phone:419-357-1693
Mailing Address - Fax:
Practice Address - Street 1:138 E MARKET ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-2506
Practice Address - Country:US
Practice Address - Phone:419-621-9377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.003988175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist