Provider Demographics
NPI:1275141087
Name:RENFROE, WHITNEY (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:
Last Name:RENFROE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 BUNDY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-2917
Mailing Address - Country:US
Mailing Address - Phone:765-591-4190
Mailing Address - Fax:765-381-1200
Practice Address - Street 1:1912 BUNDY AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-2917
Practice Address - Country:US
Practice Address - Phone:765-591-4190
Practice Address - Fax:765-381-1200
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31007186A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN31007186AOtherSTATE LICENSE