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General NPI Number Information
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NPI Number | 1710840871
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Entity Type | Organization
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Legal Business Name | RENEWED THERAPEUTICS LLC
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 960 E 53RD ST
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City | DAVENPORT
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State | IA
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Zip | 52807-2613
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Country | US
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Telephone | 563-219-7002
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Fax |
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Provider Business Mailing Address
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Address Line | 361 N 8TH ST
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City | LE CLAIRE
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State | IA
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Zip | 52753-8606
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Country | US
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Telephone | 319-540-5738
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACLYN MARIE JACOBI
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Credential | OT
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Telephone | 319-540-5738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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