Provider Demographics
NPI:1174759609
Name:THORP-SUDOL, RENEE FRANCES (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:FRANCES
Last Name:THORP-SUDOL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:RENEE
Other - Middle Name:FRANCES
Other - Last Name:THORP-GOMOLKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:8729 SUDAL HILL RD
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13309-4549
Mailing Address - Country:US
Mailing Address - Phone:315-942-3197
Mailing Address - Fax:315-942-3197
Practice Address - Street 1:8729 SUDAL HILL RD
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:NY
Practice Address - Zip Code:13309-4549
Practice Address - Country:US
Practice Address - Phone:315-942-3197
Practice Address - Fax:315-942-3197
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012473-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor