Provider Demographics
NPI:1669073664
Name:REUTER, DARYL JAMES (BOCO, COF)
Entity type:Individual
Prefix:MR
First Name:DARYL
Middle Name:JAMES
Last Name:REUTER
Suffix:
Gender:M
Credentials:BOCO, COF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 PARK ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2363
Mailing Address - Country:US
Mailing Address - Phone:508-222-1972
Mailing Address - Fax:888-501-5898
Practice Address - Street 1:51 PARK ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2363
Practice Address - Country:US
Practice Address - Phone:401-301-5633
Practice Address - Fax:888-501-5898
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC16275222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1932164464OtherNPPES