Provider Demographics
NPI:1518422377
Name:REYNOLDS, MARIE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
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 1:1201 W BOYD ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-4801
Mailing Address - Country:US
Mailing Address - Phone:405-366-7898
Mailing Address - Fax:405-366-0010
Practice Address - Street 1:1201 W BOYD ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-4801
Practice Address - Country:US
Practice Address - Phone:405-366-7898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2024-08-27
Deactivation Date:2024-08-14
Deactivation Code:
Reactivation Date:2024-08-27
Provider Licenses
StateLicense IDTaxonomies
OK5980225XP0200X
OKRBT-19-77394106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics