Provider Demographics
NPI:1104947738
Name:HARSHBARGER, RENEE L (ORT,L)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:L
Last Name:HARSHBARGER
Suffix:
Gender:F
Credentials:ORT,L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5754 LOGAN ARMS DR
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-1642
Mailing Address - Country:US
Mailing Address - Phone:330-518-2215
Mailing Address - Fax:
Practice Address - Street 1:45 N CANFIELD NILES RD
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2343
Practice Address - Country:US
Practice Address - Phone:330-518-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-902225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341938609OtherTAX ID
OH600494OtherUNITED HEALTH CARE
OH000000214382OtherANTHEM
OH000000214382OtherANTHEM