Basic Information
| Provider Information | |||||||||
| NPI: | 1235604794 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PENNER | ||||||||
| FirstName: | LINDSEY | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2201 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | GLADEWATER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756475373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5125841417 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1154 E HAWKINS PKWY | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756057975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036632750 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2018 | ||||||||
| LastUpdateDate: | 10/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 211351 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.