Active NPI
Renee D Phares, OTR
- Pediatric Occupational Therapist
- Minneola, FL
National Provider Identifier
1639266091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- License
- OT1509
- Practice address
- 405 S Seminole Ave
Minneola, FL 34715-5520 - Phone
- (352) 394-0212
- Fax
- (352) 241-6361
- NPI assigned
- Oct 6, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | OT1509 | FL | Primary |
Addresses
Primary practice location
405 S Seminole Ave
Minneola, FL 34715-5520
Mailing address
17355 Cork St
Winter Garden, FL 34787-9700
Phone (407) 654-7624
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT1509 | FL | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1639266091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17355 CORK ST",
"city": "WINTER GARDEN",
"state": "FL",
"postal_code": "347879700",
"telephone_number": "407-654-7624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 S SEMINOLE AVE",
"city": "MINNEOLA",
"state": "FL",
"postal_code": "347155520",
"telephone_number": "352-394-0212",
"fax_number": "352-241-6361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHARES",
"first_name": "RENEE",
"middle_name": "D",
"name_prefix": "Mrs.",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-06",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "FL",
"license": "OT1509",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneola, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.