Provider Demographics
NPI:1528272291
Name:REYNOLDS, CATHY D (DT)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:D
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 W SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-1433
Mailing Address - Country:US
Mailing Address - Phone:618-498-2279
Mailing Address - Fax:
Practice Address - Street 1:704 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-1433
Practice Address - Country:US
Practice Address - Phone:618-498-2279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist