Provider Demographics
NPI:1659934313
Name:KATZ, RENEE S (MT)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:S
Last Name:KATZ
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 OLD TOWER HILL RD
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3739
Mailing Address - Country:US
Mailing Address - Phone:401-864-0947
Mailing Address - Fax:
Practice Address - Street 1:133 OLD TOWER HILL RD STE 5
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3700
Practice Address - Country:US
Practice Address - Phone:401-864-0947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI0090225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist