Provider Demographics
NPI:1750148235
Name:FLEAK, REILLEY KATE
Entity type:Individual
Prefix:MRS
First Name:REILLEY
Middle Name:KATE
Last Name:FLEAK
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 1:345 SCHULTZ MILL RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26181-5306
Mailing Address - Country:US
Mailing Address - Phone:304-991-2131
Mailing Address - Fax:
Practice Address - Street 1:1210 13TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-4144
Practice Address - Country:US
Practice Address - Phone:304-420-9663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2386225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist