Individual
MRS. PENNY LORI BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2401 DEVELOPMENT BLVD, WACO, TX 76705-2903
(512) 799-7339
Mailing address
2401 DEVELOPMENT BLVD, WACO, TX 76705-2903
(512) 799-7339
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
211418
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NO IDENTIFIER NO AVAILABLE
—
Enumeration date
12/16/2018
Last updated
12/16/2018
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