Provider Demographics
NPI:1306488416
Name:FROST, RENEE (RENEE FROST COTA/L)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:FROST
Suffix:
Gender:F
Credentials:RENEE FROST COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 UNDERHILL RD S
Mailing Address - Street 2:
Mailing Address - City:POUGHQUAG
Mailing Address - State:NY
Mailing Address - Zip Code:12570-5224
Mailing Address - Country:US
Mailing Address - Phone:845-625-8830
Mailing Address - Fax:
Practice Address - Street 1:706 OLD STATE ROUTE 22
Practice Address - Street 2:
Practice Address - City:DOVER PLAINS
Practice Address - State:NY
Practice Address - Zip Code:12522-5818
Practice Address - Country:US
Practice Address - Phone:845-453-2385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010264224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant