Provider Demographics
NPI:1700977634
Name:RENNIE, PRISCILLA C (OT/L)
Entity Type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:C
Last Name:RENNIE
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:C
Other - Last Name:VOGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:806 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246
Mailing Address - Country:US
Mailing Address - Phone:603-524-9090
Mailing Address - Fax:603-524-1497
Practice Address - Street 1:806 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246
Practice Address - Country:US
Practice Address - Phone:603-524-9090
Practice Address - Fax:603-524-1497
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0304225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2486344OtherAETNA
NH1300449Y0NH01OtherANTHEM BC/BS
NH30412209Medicaid
NHRE RE6124Medicare ID - Type Unspecified