Individual
MS. MARY L PENNINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
17-02214
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
013980
BLUE SHIELD
KS
Enumeration date
04/20/2006
Last updated
12/19/2007
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