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Organization
NICOLE REYNOLDS LLC
Active
Organization
NICOLE REYNOLDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE REYNOLDS (OCCUPATIONAL THERAPIST)
(716) 481-2248
Entity
Organization
Contact information
Practice address
1015 LAKE SHORE DR APT 102, LAKE PARK, FL 33403-2800
(716) 481-2248
Mailing address
1015 LAKE SHORE DR APT 102, LAKE PARK, FL 33403-2800
(716) 481-2248
Taxonomy
Speciality
Code
Description
License number
State
225XN1300X
Neurorehabilitation Occupational Therapist
Primary
—
NULL
225XN1300X
Neurorehabilitation Occupational Therapist
Primary
—
—
Other
Enumeration date
05/20/2021
Last updated
05/20/2021
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