Provider Demographics
NPI:1346500717
Name:GOLDMAN, PENNY ELLEN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:ELLEN
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10492 NW 56TH DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2804
Mailing Address - Country:US
Mailing Address - Phone:954-294-1028
Mailing Address - Fax:
Practice Address - Street 1:10492 NW 56TH DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-2804
Practice Address - Country:US
Practice Address - Phone:954-294-1028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-20
Last Update Date:2013-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist