Provider Demographics
NPI:1497274484
Name:KORTRIGHT, RENEE L
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:L
Last Name:KORTRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 SCHUMWAY RD
Mailing Address - Street 2:
Mailing Address - City:NEVERSINK
Mailing Address - State:NY
Mailing Address - Zip Code:12765-5237
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:177 SCHUMWAY RD
Practice Address - Street 2:
Practice Address - City:NEVERSINK
Practice Address - State:NY
Practice Address - Zip Code:12765-5237
Practice Address - Country:US
Practice Address - Phone:845-701-0729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009362-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant