Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 17358 | FL |
NPI | 1023658044 |
---|---|
Provider Name | Yvonne Penn |
First Address | Oviedo, FL 32765-7066 |
Second Address | Orlando, FL 32803-5200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2020 |
Last Update Date | 07/01/2020 |