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NPI Code Detail

MEDICARE: MARY RENNER OTR/L

MEDICARE: MARY RENNER 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
1225X00000XOccupational TherapistOT 14859FL

General Provider Information

NPI Number : 1235407180
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY RENNER OTR/L
Provider Business Mailing Address
First Line : 934 PIKE RD
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33411-3849
Country : US
Telephone Number : 727-520-2953
Fax Number :
Provider Business Practice Location Address
First Line : 5100 CRESTHAVEN BLVD
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33415-8618
Country : US
Telephone Number : 561-964-2828
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2011
Last Update Date : 05/14/2015

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Directions to “ MARY RENNER OTR/L” Practice Location

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