Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 3094-026 | WI |
N | 225XG0600X | Occupational Therapist - Gerontology | 3094-026 | WI |
N | 225XL0004X | Low Vision | 3094-026 | WI |
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 3094-026 | WI |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 3094-026 | WI |
N | 225XR0403X | Driving and Community Mobility | 3094-026 | WI |
NPI | 1629744834 |
---|---|
Provider Name | Andrea Labelle Reynolds |
First Address | Wauwatosa, WI 53213-1012 |
Second Address | Summit, WI 53066-4899 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2021 |
Last Update Date | 18/08/2021 |