Provider Demographics
NPI:1497112593
Name:FELICE, RENE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:RENE
Middle Name:
Last Name:FELICE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:RENE
Other - Middle Name:
Other - Last Name:FELICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:2020 SAINT REGIS DR.
Mailing Address - Street 2:APT. 402
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 SAINT REGIS DR
Practice Address - Street 2:APT. 402
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6206
Practice Address - Country:US
Practice Address - Phone:630-261-1545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057001307224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant