Provider Demographics
NPI:1962468447
Name:KILTY, RENEE (OTR)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:KILTY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:3541 PLOVER RD
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-2155
Mailing Address - Country:US
Mailing Address - Phone:715-423-5423
Mailing Address - Fax:
Practice Address - Street 1:3541 PLOVER RD
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-2155
Practice Address - Country:US
Practice Address - Phone:715-423-5423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103276225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist