Provider Demographics
NPI:1902308182
Name:RENEAU, KEELIE (MOT OTR)
Entity Type:Individual
Prefix:
First Name:KEELIE
Middle Name:
Last Name:RENEAU
Suffix:
Gender:F
Credentials:MOT OTR
Other - Prefix:
Other - First Name:KEELIE
Other - Middle Name:
Other - Last Name:WASHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT OTR
Mailing Address - Street 1:5924 ROYAL LN # 261
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-3863
Mailing Address - Country:US
Mailing Address - Phone:214-360-7500
Mailing Address - Fax:
Practice Address - Street 1:5924 ROYAL LN STE 261
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-3863
Practice Address - Country:US
Practice Address - Phone:214-360-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114630225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist