Basic Information
| Provider Information | |||||||||
| NPI: | 1508315466 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ROUNDER | ||||||||
| FirstName: | REECE | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 165 NATCHEZ TRACE AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421037940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707964698 | ||||||||
| FaxNumber: | 2707823274 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 CROSSLAKE DR | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477158198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124771558 | ||||||||
| FaxNumber: | 8124742296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2016 | ||||||||
| LastUpdateDate: | 11/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 171046 | KY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 31006558A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.