Individual
PENELOPE WOODWARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
490 N DIAMOND AVE, CANON CITY, CO 81212-2521
(719) 276-6174
(719) 276-6199
Mailing address
700 S 8TH ST, CANON CITY, CO 81212-4906
(719) 207-0994
(719) 276-6199
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
0031319
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95138340
—
CO
Enumeration date
07/18/2013
Last updated
07/18/2013
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