Provider Demographics
NPI:1457676066
Name:ROBERTS, RENEE LATIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:LATIA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4864 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-1422
Mailing Address - Country:US
Mailing Address - Phone:954-593-0173
Mailing Address - Fax:
Practice Address - Street 1:23315 BLUE WATER CIR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7053
Practice Address - Country:US
Practice Address - Phone:561-368-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13829225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist