Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 131000145 | VA |
NPI | 1023561479 |
---|---|
Provider Name | Toby Pennell |
First Address | Suffolk, VA 23434-4529 |
Second Address | Suffolk, VA 23434-4529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2016 |
Last Update Date | 08/11/2019 |