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Individual

QUETZALLI PENALOZA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
286 EASTLAWN AVE, SAINT ROBERT, MO 65584-3702
(573) 842-2100
Mailing address
9831 STATE HIGHWAY 76, FORSYTH, MO 65653-5442
(417) 559-1814

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2023009181
MO

Other

Enumeration date
06/10/2024
Last updated
06/10/2024
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