Provider Demographics
NPI:1740669779
Name:RENGERING, LEANN MARIE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:LEANN
Middle Name:MARIE
Last Name:RENGERING
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:LEANN
Other - Middle Name:MARIE
Other - Last Name:COLLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:4367 CONCORD BLVD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-1145
Mailing Address - Country:US
Mailing Address - Phone:925-689-7457
Mailing Address - Fax:925-689-7473
Practice Address - Street 1:4367 CONCORD BLVD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-1145
Practice Address - Country:US
Practice Address - Phone:925-689-7457
Practice Address - Fax:925-689-7473
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3158314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility