Provider Demographics
NPI:1316312481
Name:TEMPEST, RENEE MICHELLE (OTR/L)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:MICHELLE
Last Name:TEMPEST
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 1:10860 PENINSULA CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20111-4390
Mailing Address - Country:US
Mailing Address - Phone:785-313-1624
Mailing Address - Fax:
Practice Address - Street 1:14130 NOBLEWOOD PLZ STE 301
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1467
Practice Address - Country:US
Practice Address - Phone:571-402-7550
Practice Address - Fax:703-237-2729
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006792225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics