Provider Demographics
NPI:1104491927
Name:HAVEL, RENEE T (175TOOOOOX)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:T
Last Name:HAVEL
Suffix:
Gender:F
Credentials:175TOOOOOX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38350 OAK HILL LN APT 2
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7618
Mailing Address - Country:US
Mailing Address - Phone:440-796-8410
Mailing Address - Fax:
Practice Address - Street 1:38350 OAK HILL LN APT 2
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-7618
Practice Address - Country:US
Practice Address - Phone:440-796-8410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
OH0002346175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist