Provider Demographics
NPI:1114536471
Name:WHITMIRE, RENEE (MOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:WHITMIRE
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17825 W SIERRA MONTANA LOOP
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-7880
Mailing Address - Country:US
Mailing Address - Phone:623-523-8700
Mailing Address - Fax:
Practice Address - Street 1:17825 W SIERRA MONTANA LOOP
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-7880
Practice Address - Country:US
Practice Address - Phone:623-523-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-005691225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist