Individual
M. RENEE WILLMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1825 FORTVIEW RD, SUITE 103, AUSTIN, TX 78704-7657
(512) 444-4263
(512) 444-4254
Mailing address
1825 FORTVIEW RD, SUITE 103, AUSTIN, TX 78704-7657
(512) 444-4263
(512) 444-4264
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
104079
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0A5012
MEDICARE GROUP PTAN
TX
01
—
104079
STATE
TX
01
—
847T18
BCBSTX PROVIDER NUMBER
TX
01
—
TXB108109
MEDICARE PTAN
TX
Enumeration date
02/07/2007
Last updated
03/30/2012
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