Stacey Ellice Reynolds, OTRL
Individual provider Active NPI Pediatric Occupational Therapist · Manakin Sabot, VA
NPI 1578601415 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1578601415
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Occupational Therapist 225XP0200X
- License
- 0119004113 (VA)
- Practice address
- 40 Broad Street Rd
Manakin Sabot, VA 23103-2213 - Phone
- (804) 784-3514
- Fax
- (804) 784-4514
- NPI assigned
- Feb 2, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0119004113 | VA | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Integrated Therapy Services | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 0119004113 | VA | Yes |
Addresses
Primary practice location
40 Broad Street Rd
Manakin Sabot, VA 23103-2213
Mailing address
1509 Wentbridge Rd
Richmond, VA 23227-4730
Phone (410) 241-2140
Other providers in Manakin Sabot, VA
- Lois Hermann Phillips
- Kelly Corke Pledger
- Traci Coyle Qureshi
- Reena Rana
- Renaissance Healthcare Group Virginia, LLC
- Kevin Wayne Ruff
- Sarah C Wilmer DDS PLLC
- Bruce A Silverman
- Speares Chiropractic and Sports Care LLC
- Jordan Speares
All providers in Manakin Sabot, VA · Pediatric Occupational Therapist in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.