Provider Demographics
NPI:1811470016
Name:REEL, MARYSA S (SLP)
Entity type:Individual
Prefix:
First Name:MARYSA
Middle Name:S
Last Name:REEL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 CARTER BRAXTON DR
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:WV
Mailing Address - Zip Code:26601-9592
Mailing Address - Country:US
Mailing Address - Phone:304-765-7101
Mailing Address - Fax:304-765-7148
Practice Address - Street 1:98 CARTER BRAXTON DR
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601-9592
Practice Address - Country:US
Practice Address - Phone:304-765-7101
Practice Address - Fax:304-765-7148
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1887235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist