MEDICARE: CHRYSANTHE RENIERIS OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	5201006339	MI

General Provider Information

NPI Number	:	1124131305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRYSANTHE RENIERIS OTR/L

Provider Business Mailing Address
First Line	:	3425 EXECUTIVE PKWY
Second Line	:	SUITE 128
City	:	TOLEDO
State	:	OH
Zip	:	43606-1326
Country	:	US
Telephone Number	:	419-537-0764
Fax Number	:	419-537-0948

Provider Business Practice Location Address
First Line	:	6010 W MAPLE RD
Second Line	:	SUITE 215
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4406
Country	:	US
Telephone Number	:	248-539-2900
Fax Number	:	248-538-2901

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/08/2007

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