Provider Demographics
NPI:1477670412
Name:HAUSSMANN, PENNY (MOT OTR/L, CLT)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:
Last Name:HAUSSMANN
Suffix:
Gender:F
Credentials:MOT OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7122 S SHERIDAN RD
Mailing Address - Street 2:SUITE 2-564
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-2748
Mailing Address - Country:US
Mailing Address - Phone:580-276-6656
Mailing Address - Fax:888-857-0023
Practice Address - Street 1:7040 S YALE AVENUE
Practice Address - Street 2:SUITE 750
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-2748
Practice Address - Country:US
Practice Address - Phone:580-276-6656
Practice Address - Fax:888-857-0023
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111074225X00000X
OK864225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist