Provider Demographics
NPI:1104183177
Name:PENNING, CAROLYN SCHMIDT (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:SCHMIDT
Last Name:PENNING
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:CAROLYN
Other - Middle Name:MARGARET
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:2132 HOFFMAN RD.
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001
Mailing Address - Country:US
Mailing Address - Phone:507-386-7401
Mailing Address - Fax:507-386-1379
Practice Address - Street 1:2132 HOFFMAN RD
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-386-7401
Practice Address - Fax:507-386-1379
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101435225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist