Individual
MRS. SUSAN LAVERNE RENARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1760 SHAWANO AVE, GREEN BAY, WI 54303-3216
(920) 499-5191
(920) 499-8959
Mailing address
1760 SHAWANO AVE, GREEN BAY, WI 54303-3216
(920) 499-5191
(920) 499-8959
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
392-27
WI
Other
Enumeration date
11/30/2010
Last updated
11/30/2010
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