Individual
TAMARA PENNY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1304 E CORAL WAY, GRAND PRAIRIE, TX 75051
(972) 237-4000
Mailing address
7129 HIGHTOWER ST, FORT WORTH, TX 76112
(817) 999-3376
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
105724
TX
Other
Enumeration date
11/08/2021
Last updated
11/08/2021
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