Provider Demographics
NPI:1053708321
Name:VARNEY, RENEE (OTR/L)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:VARNEY
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 1:59 WOODSCAPE DR
Mailing Address - Street 2:
Mailing Address - City:FORT EDWARD
Mailing Address - State:NY
Mailing Address - Zip Code:12828-2479
Mailing Address - Country:US
Mailing Address - Phone:518-636-5862
Mailing Address - Fax:
Practice Address - Street 1:170 WARREN ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4525
Practice Address - Country:US
Practice Address - Phone:518-793-5163
Practice Address - Fax:518-793-5165
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63 013051225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52-2418940OtherEIN
NY52-2418940OtherEIN