Individual
ANDREA E PENACHO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
721 RESERVOIR AVE, CRANSTON, RI 02910-4430
(401) 946-4250
(401) 275-5645
Mailing address
227 GREENBRIER DR, SEEKONK, MA 02771-5647
(401) 484-4989
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT00513
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
408949
BLUECHIP RI IND. ID#
RI
Enumeration date
05/11/2006
Last updated
01/04/2021
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