Basic Information
| Provider Information | |||||||||
| NPI: | 1245909712 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RENTEL | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | RALPH | ||||||||
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| NameSuffix: | III | ||||||||
| Credential: | OTR/L. D/PAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 531 CEDAR CREEK RD APT 11 | ||||||||
| Address2: | |||||||||
| City: | PIKEVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 415011415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237946227 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 945 W RUSSELL ST | ||||||||
| Address2: | |||||||||
| City: | ELKHORN CITY | ||||||||
| State: | KY | ||||||||
| PostalCode: | 415229032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443343818 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2021 | ||||||||
| LastUpdateDate: | 09/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 262588 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.