Individual
TYRONE PENNY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RBT , ARF
Contact information
Practice address
564 PIRINEN LN APT C, MODESTO, CA 95354-2010
(209) 486-5175
Mailing address
12091 E WHITMORE AVE, MODESTO, CA 95236
(209) 883-1201
Taxonomy
Speciality
Code
Description
License number
State
225XM0800X
Mental Health Occupational Therapist
Primary
B6770816
CA
Other
Enumeration date
07/30/2021
Last updated
07/30/2021
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