Individual
SHELLY PENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1020 HILL ST, WATERTOWN, WI 53098-3016
(920) 206-4935
Mailing address
116 DAYTON ST APT B, WATERTOWN, WI 53094-3610
(608) 566-0113
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5026-27
WI
Other
Enumeration date
05/12/2014
Last updated
05/12/2014
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