Provider Demographics
NPI:1821242066
Name:VIOLETT, RENEE DELENE
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:DELENE
Last Name:VIOLETT
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 1:1901 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-2839
Mailing Address - Country:US
Mailing Address - Phone:618-942-3274
Mailing Address - Fax:618-942-8240
Practice Address - Street 1:1901 N 13TH ST
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-2839
Practice Address - Country:US
Practice Address - Phone:618-942-3274
Practice Address - Fax:618-942-8240
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2023-12-14
Deactivation Date:2023-12-05
Deactivation Code:
Reactivation Date:2023-12-14
Provider Licenses
StateLicense IDTaxonomies
IL057.002728224Z00000X
IL56009467225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant