Provider Demographics
NPI:1992438006
Name:NIEMIEC, RENEE (OTR/L)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:NIEMIEC
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 1:814 DALE DR
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-2151
Mailing Address - Country:US
Mailing Address - Phone:570-499-5835
Mailing Address - Fax:
Practice Address - Street 1:64 RIDGWAY DR STE 1
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-9263
Practice Address - Country:US
Practice Address - Phone:570-255-4578
Practice Address - Fax:570-255-4575
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002075L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist