Healthcare Provider Details

I. General information

NPI: 1437132925
Provider Name (Legal Business Name): RENAE LEWANDOWSKI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 INTELCO LOOP SE, STE B
LACEY WA
98503
US

IV. Provider business mailing address

4510 INTELCO LOOP SE, STE. B
LACEY WA
98503
US

V. Phone/Fax

Practice location:
  • Phone: 360-786-1753
  • Fax: 360-786-1793
Mailing address:
  • Phone: 360-786-1753
  • Fax: 360-786-1793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT00002052
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: