Provider Demographics
NPI:1316076284
Name:RENNO, KELLY L (OTR,L)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:L
Last Name:RENNO
Suffix:
Gender:F
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 1:261 ELLIS TURNER RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-7151
Mailing Address - Country:US
Mailing Address - Phone:570-387-0922
Mailing Address - Fax:
Practice Address - Street 1:398 WALL ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-1744
Practice Address - Country:US
Practice Address - Phone:570-275-4047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009064225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics