Provider Demographics
NPI:1437288487
Name:PENA, CAROLYN M (OT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:PENA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:610-991-2034
Mailing Address - Fax:610-438-2046
Practice Address - Street 1:7949 SUNMOUNT DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-4892
Practice Address - Country:US
Practice Address - Phone:610-991-2034
Practice Address - Fax:610-438-2046
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676626Medicare Oscar/Certification
TX676600Medicare Oscar/Certification
TX676554Medicare Oscar/Certification
TX676564Medicare Oscar/Certification
TX676555Medicare Oscar/Certification
TX676559Medicare Oscar/Certification
TX00936XMedicare ID - Type UnspecifiedPART B GROUP NUMBER