Provider Demographics
NPI:1437352218
Name:POHLEVEN, RENAY SUE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:RENAY
Middle Name:SUE
Last Name:POHLEVEN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:RENAY
Other - Middle Name:SUE
Other - Last Name:AMENDOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1999 NEWPORT RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13431-1714
Mailing Address - Country:US
Mailing Address - Phone:315-845-8914
Mailing Address - Fax:
Practice Address - Street 1:1657 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5415
Practice Address - Country:US
Practice Address - Phone:315-797-7392
Practice Address - Fax:315-734-9041
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010445-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist