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Individual

MISS RENEA OUTLAW

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
COTA/L

Contact information

Practice address
1945 DAVIS DR, GADSDEN, AL 35904-3276
(256) 543-1030
Mailing address
205 7TH ST S, AMORY, MS 38821-3616
(662) 640-9520

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3630
AL
224Z00000X
Occupational Therapy Assistant
TA2835
MS

Other

Enumeration date
05/13/2014
Last updated
05/13/2014
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