Provider Demographics
NPI:1437799947
Name:MUMPER, RENEE LYNN (OTR)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:LYNN
Last Name:MUMPER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6107 BABL LN
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-1966
Mailing Address - Country:US
Mailing Address - Phone:715-370-7508
Mailing Address - Fax:
Practice Address - Street 1:3312 TERRACE CT
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4904
Practice Address - Country:US
Practice Address - Phone:715-370-1932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2220-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist