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General NPI Number Information
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NPI Number | 1598957433
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Entity Type | Individual
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Provider Name | RENAE MAREE FENNELL OTR/L.
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Gender | Female
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 08/14/2007
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Provider Practice Location Address
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Address Line | 7144 WINDING LAKE CIR
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City | OVIEDO
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State | FL
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Zip | 32765-5650
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Country | US
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Telephone | 407-359-5695
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Fax | 407-359-5695
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Provider Business Mailing Address
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Address Line | 7144 WINDING LAKE CIR
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City | OVIEDO
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State | FL
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Zip | 32765-5650
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Country | US
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Telephone | 407-359-5695
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Fax | 407-359-5695
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 5265
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 5265
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License Number State | FL
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