Healthcare Provider Details

I. General information

NPI: 1316312481
Provider Name (Legal Business Name): RENEE MICHELLE TEMPEST OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14130 NOBLEWOOD PLZ STE 301
WOODBRIDGE VA
22193-1467
US

IV. Provider business mailing address

10860 PENINSULA CT
MANASSAS VA
20111-4390
US

V. Phone/Fax

Practice location:
  • Phone: 571-402-7550
  • Fax: 703-237-2729
Mailing address:
  • Phone: 785-313-1624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0119006792
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: