Provider Demographics
NPI:1417436395
Name:ZORN, RENEE (COTA)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:ZORN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-5252
Mailing Address - Country:US
Mailing Address - Phone:903-922-2654
Mailing Address - Fax:
Practice Address - Street 1:2212 W REAGAN ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-2222
Practice Address - Country:US
Practice Address - Phone:903-727-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207776224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant