Provider Demographics
NPI:1598957433
Name:FENNELL, RENAE MAREE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:RENAE
Middle Name:MAREE
Last Name:FENNELL
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 1:7144 WINDING LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5650
Mailing Address - Country:US
Mailing Address - Phone:407-359-5695
Mailing Address - Fax:407-359-5695
Practice Address - Street 1:7144 WINDING LAKE CIR
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5650
Practice Address - Country:US
Practice Address - Phone:407-359-5695
Practice Address - Fax:407-359-5695
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5265171W00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No251C00000XAgenciesDay Training, Developmentally Disabled Services