Provider Demographics
NPI:1073749453
Name:MISH, RENEE ELIZABETH (MS, OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:RENEE
Middle Name:ELIZABETH
Last Name:MISH
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1683 BULL YEARLING RD
Mailing Address - Street 2:
Mailing Address - City:STANARDSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22973-2610
Mailing Address - Country:US
Mailing Address - Phone:434-409-0949
Mailing Address - Fax:
Practice Address - Street 1:1683 BULL YEARLING RD
Practice Address - Street 2:
Practice Address - City:STANARDSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22973-2610
Practice Address - Country:US
Practice Address - Phone:434-409-0949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-30
Last Update Date:2009-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003867225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist