Individual
STACI LANIESE PENNER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
600 MEDICAL CENTER DR, NEWTON, KS 67114-8780
(316) 283-2700
Mailing address
633 WESTCHESTER LN, NEWTON, KS 67114-1248
(316) 284-9976
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1701637
KS
Other
Enumeration date
03/10/2006
Last updated
07/08/2007
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