Nicole Reynolds LLC

Primary specialty

Neurorehabilitation Occupational TherapistTaxonomy code 225XN1300X

Legal business name

NICOLE REYNOLDS LLC

Practice address

1015 Lake Shore Dr Apt 102
Lake Park, FL 33403-2800

Phone

(716) 481-2248

NPI assigned

May 20, 2021

Organization subpart

No

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

Authorized official

Name

Nicole ReynoldsNPI 1467843482

Title

Occupational Therapist

Phone

(716) 481-2248

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nicole Reynolds

  • Occupational Therapist
  • Alden, NY
  • NPI 1467843482

  FL

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1621468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621468800000",
    "number": "1285209429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 LAKE SHORE DR APT 102",
            "city": "LAKE PARK",
            "state": "FL",
            "postal_code": "334032800",
            "telephone_number": "716-481-2248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 LAKE SHORE DR APT 102",
            "city": "LAKE PARK",
            "state": "FL",
            "postal_code": "334032800",
            "telephone_number": "716-481-2248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICOLE REYNOLDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-20",
        "last_updated": "2021-05-20",
        "certification_date": "2021-05-20",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "716-481-2248"
    },
    "taxonomies": [
        {
            "code": "225XN1300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist, Neurorehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Neurorehabilitation Occupational Therapist in Lake Park, FL
• Providers in Lake Park, FL by specialty
• Neurorehabilitation Occupational Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.