Provider Demographics
NPI:1881116507
Name:STUART, RENEE ANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:ANNE
Last Name:STUART
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 CHARLES TOWNE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-3074
Mailing Address - Country:US
Mailing Address - Phone:803-479-6115
Mailing Address - Fax:
Practice Address - Street 1:234 CHARLES TOWNE CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-3074
Practice Address - Country:US
Practice Address - Phone:803-479-6115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4989225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist