Individual
WILLIAM D PENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
3734 PIEDRAS NEGRAS DR, LAS CRUCES, NM 88012-7671
(575) 642-0920
Mailing address
3734 PIEDRAS NEGRAS DR, LAS CRUCES, NM 88012-7671
(575) 642-0920
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2505
NM
Other
Enumeration date
01/29/2012
Last updated
01/29/2012
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