Herbert Allen Reynolds III, OTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OA1810 Issued in ME

Practice address

103 Texas Ave
Bangor, ME 04401-4324

Phone

(207) 947-4557

NPI assigned

Oct 20, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1697760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697760000000",
    "number": "1225810401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 MEMORIAL DR",
            "city": "WINTERPORT",
            "state": "ME",
            "postal_code": "044963447",
            "telephone_number": "207-249-5293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 TEXAS AVE",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014324",
            "telephone_number": "207-947-4557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "HERBERT",
        "middle_name": "ALLEN",
        "name_suffix": "III",
        "credential": "OTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-10-20",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "ME",
            "license": "OA1810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Respiratory Care of Maine PA
• Restoration Health LLC
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• Revival LLC
• Diane Marion Reynolds, PA-C
• Jaclyn Taylor Reynolds, PMHNP
• Emily Marie Rhodes, LCPC-C
• Aric Paul Rice
• Helen Virgina Rice, RNC BSN
• Mindy L. Rice, LCPC

• Occupational Therapy Assistant in Bangor, ME
• Providers in Bangor, ME by specialty
• Occupational Therapy Assistant in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.