Provider Demographics
NPI:1104397462
Name:FOOR, RENEE ABIGAIL (DT)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:ABIGAIL
Last Name:FOOR
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 W 51ST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-2306
Mailing Address - Country:US
Mailing Address - Phone:704-618-4940
Mailing Address - Fax:
Practice Address - Street 1:1925 W 51ST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46228-2306
Practice Address - Country:US
Practice Address - Phone:704-618-4940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty