Basic Information
| Provider Information | |||||||||
| NPI: | 1578126520 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARSOP | ||||||||
| FirstName: | PENNY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | COTAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 N MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | COLDWATER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490361527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172799808 | ||||||||
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| Practice Location | |||||||||
| Address1: | 90 N MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | COLDWATER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490361527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172799808 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2019 | ||||||||
| LastUpdateDate: | 04/16/2019 | ||||||||
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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 | 5202007276 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
ID Information
| ID | Type | State | Issuer | Description | 5202007276 | 01 | MI | BOARD OF LICENSING FOR OCCUPATIONAL THERAPY | OTHER |