Healthcare Provider Details

I. General information

NPI: 1528021995
Provider Name (Legal Business Name): RENEE M FROST OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEE ETCHAMENDY

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 W. YELM AVE.
YELM WA
98597-7679
US

IV. Provider business mailing address

100 DENNIS ST SW STE B
TUMWATER WA
98501-6523
US

V. Phone/Fax

Practice location:
  • Phone: 360-458-2444
  • Fax: 360-458-2747
Mailing address:
  • Phone: 360-338-0181
  • Fax: 360-338-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: