Provider Demographics
NPI:1528102761
Name:DINGLE, RENEE (OTR)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:DINGLE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10902 AUSTRAILIAN PINE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-2332
Mailing Address - Country:US
Mailing Address - Phone:813-236-9239
Mailing Address - Fax:
Practice Address - Street 1:10902 AUSTRAILIAN PINE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-2332
Practice Address - Country:US
Practice Address - Phone:813-236-9239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 11535224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant