Provider Demographics
NPI:1669774410
Name:RENNER, MERCY (COTA/L)
Entity type:Individual
Prefix:
First Name:MERCY
Middle Name:
Last Name:RENNER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 WALTON AVE
Mailing Address - Street 2:APT #5H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8424
Mailing Address - Country:US
Mailing Address - Phone:212-866-0666
Mailing Address - Fax:212-866-2036
Practice Address - Street 1:1176 WALTON AVE
Practice Address - Street 2:APT #5H
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8424
Practice Address - Country:US
Practice Address - Phone:212-866-0666
Practice Address - Fax:212-866-2036
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005667174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist