Individual
PENNE CLOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
251 LINDEN AVE, SOUTHGATE, KY 41071-3213
(859) 757-7765
Mailing address
251 LINDEN AVE, SOUTHGATE, KY 41071-3213
(859) 757-7765
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
133698
KY
Other
Enumeration date
08/01/2016
Last updated
08/01/2016
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