Individual
MS. MARY L PENNINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
120 W 8TH ST, ONAGA, KS 66521-9574
(785) 889-4921
(785) 889-4117
Mailing address
705 CLEO ST, HAVENSVILLE, KS 66432-9565
(785) 948-2110
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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