Provider Demographics
NPI:1497422877
Name:RENICK, CATHERINE LEIBBRANDT (CCLS)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:LEIBBRANDT
Last Name:RENICK
Suffix:
Gender:F
Credentials:CCLS
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:RACHEL
Other - Last Name:LEIBBRANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCLS
Mailing Address - Street 1:328 N BAY HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-4905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:328 N BAY HILLS BLVD
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-4905
Practice Address - Country:US
Practice Address - Phone:813-400-6697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist