Provider Demographics
NPI:1841648060
Name:REED, VERA
Entity type:Individual
Prefix:
First Name:VERA
Middle Name:
Last Name:REED
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 1:2 CENTER BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-2051
Mailing Address - Country:US
Mailing Address - Phone:860-833-6376
Mailing Address - Fax:
Practice Address - Street 1:107 WILCOX RD
Practice Address - Street 2:SUITE 103
Practice Address - City:STONINGTON
Practice Address - State:CT
Practice Address - Zip Code:06378-2614
Practice Address - Country:US
Practice Address - Phone:860-833-6376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002494173C00000X, 2083S0010X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine