Provider Demographics
NPI:1831590074
Name:TALBOT, RENEE (COTA/L)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:TALBOT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:MALLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:8544 GLENBURY CT N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9081
Mailing Address - Country:US
Mailing Address - Phone:941-704-0210
Mailing Address - Fax:
Practice Address - Street 1:8544 GLENBURY CT N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9081
Practice Address - Country:US
Practice Address - Phone:941-704-0210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 13584172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker