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General NPI Number Information
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NPI Number | 1639266091
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Entity Type | Individual
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Provider Name | RENEE D PHARES OTR
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Gender | Female
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 405 S SEMINOLE AVE
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City | MINNEOLA
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State | FL
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Zip | 34715-5520
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Country | US
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Telephone | 352-394-0212
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Fax | 352-241-6361
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Provider Business Mailing Address
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Address Line | 17355 CORK ST
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City | WINTER GARDEN
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State | FL
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Zip | 34787-9700
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Country | US
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Telephone | 407-654-7624
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Fax |
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT1509
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License Number State | FL
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