Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | NY |
NPI | 1942323076 |
---|---|
Provider Name | Mrs. Kimberly J. Reynolds |
First Address | W. Haverstraw, NY 10993 |
Second Address | W. Haverstraw, NY 10993 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 08/07/2007 |