Provider Demographics
NPI:1689958944
Name:DADDONA, RENEE NICOLE (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:NICOLE
Last Name:DADDONA
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MS
Other - First Name:RENEE
Other - Middle Name:NICOLE
Other - Last Name:SAMPLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1024 FRONTIER TRL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47124-8616
Mailing Address - Country:US
Mailing Address - Phone:812-989-2199
Mailing Address - Fax:
Practice Address - Street 1:1024 FRONTIER TRAIL
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IN
Practice Address - Zip Code:47124
Practice Address - Country:US
Practice Address - Phone:812-989-2199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR4984225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist