Provider Demographics
NPI:1275726952
Name:LEVERENZ, MARK D (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:D
Last Name:LEVERENZ
Suffix:
Gender:M
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 1:7411 112TH ST
Mailing Address - Street 2:
Mailing Address - City:BLUE GRASS
Mailing Address - State:IA
Mailing Address - Zip Code:52726-9121
Mailing Address - Country:US
Mailing Address - Phone:563-343-4735
Mailing Address - Fax:
Practice Address - Street 1:101 PRAIRIE MILLS RD
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:IL
Practice Address - Zip Code:62339-1016
Practice Address - Country:US
Practice Address - Phone:217-696-4421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-25
Last Update Date:2007-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist