Provider Demographics
NPI:1740603448
Name:LUNDFELT, RENEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:LUNDFELT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:CARUSONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5 RICHARD BROWN DR
Mailing Address - Street 2:
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-1141
Mailing Address - Country:US
Mailing Address - Phone:860-848-8466
Mailing Address - Fax:
Practice Address - Street 1:5 RICHARD BROWN DR
Practice Address - Street 2:
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-1141
Practice Address - Country:US
Practice Address - Phone:860-848-8466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001668225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist