Individual
DETRA REYNOLDS-TODD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9770 JACKSON WAY, AVON, IN 46123-9588
(317) 728-4239
Mailing address
941 E RAYMOND ST, INDIANAPOLIS, IN 46203-3919
(317) 728-4239
Taxonomy
Speciality
Code
Description
License number
State
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
—
—
Other
Enumeration date
05/10/2022
Last updated
08/09/2023
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