Provider Demographics
NPI:1851472120
Name:REYNOLDS, WYLENTHIA LYNN (OTR/L)
Entity type:Individual
Prefix:
First Name:WYLENTHIA
Middle Name:LYNN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:WYLENTHIA
Other - Middle Name:LYNN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:12842 COUNTY HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-2612
Mailing Address - Country:US
Mailing Address - Phone:618-314-4431
Mailing Address - Fax:618-537-5987
Practice Address - Street 1:101 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:PINCKNEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62274-1034
Practice Address - Country:US
Practice Address - Phone:618-357-5935
Practice Address - Fax:618-357-6336
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.008726225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist