MEDICARE: MS. RENEE MICHELE MCLEAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT18627	FL

General Provider Information

NPI Number	:	1598301343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RENEE MICHELE MCLEAN

Provider Business Mailing Address
First Line	:	1102 THEODORE AVE
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3171
Country	:	US
Telephone Number	:	904-307-7263
Fax Number	:

Provider Business Practice Location Address
First Line	:	5939 ROOSEVELT BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-2356
Country	:	US
Telephone Number	:	904-307-7263
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2019
Last Update Date	:	03/19/2026

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