Individual
JACOB TODD PENNINGTON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
900 N BROADWAY ST, SUITE 1, POTEAU, OK 74953-2617
(918) 649-0772
Mailing address
PO BOX 1335, POTEAU, OK 74953-1335
(918) 649-0772
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/31/2015
Last updated
12/31/2015
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