Provider Demographics
NPI:1215106307
Name:REYNOLDS, TEMECHIUS LA'TRECE
Entity type:Individual
Prefix:
First Name:TEMECHIUS
Middle Name:LA'TRECE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 FOXCROFT DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-3420
Mailing Address - Country:US
Mailing Address - Phone:985-288-7642
Mailing Address - Fax:
Practice Address - Street 1:405 FOXCROFT DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-3420
Practice Address - Country:US
Practice Address - Phone:985-288-7642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant