Active NPI
Mitchell Reynolds
- Occupational Therapist
- Conway, AR
National Provider Identifier
1053765180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OTR2742
- Practice address
- 550 Club LN
Conway, AR 72034-3681 - Phone
- (501) 327-2495
- Fax
- (205) 683-2468
- NPI assigned
- Apr 14, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OTR2742 | AR | Primary |
Addresses
Primary practice location
550 Club LN
Conway, AR 72034-3681
Mailing address
550 Club LN
Conway, AR 72034-3681
Phone (501) 327-2495
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OTR2742 | Other | AR | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1460592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460592000000",
"number": "1053765180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "550 CLUB LN",
"city": "CONWAY",
"state": "AR",
"postal_code": "720343681",
"telephone_number": "501-327-2495",
"fax_number": "205-683-2468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 CLUB LN",
"city": "CONWAY",
"state": "AR",
"postal_code": "720343681",
"telephone_number": "501-327-2495",
"fax_number": "205-683-2468"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "MITCHELL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-04-14",
"last_updated": "2016-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "AR",
"license": "OTR2742",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "OTR2742",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Conway, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.