Provider Demographics
NPI:1558956110
Name:PENASKOVIC, AMY (OTR)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PENASKOVIC
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18217 N HILLTOP RD
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:WA
Mailing Address - Zip Code:99005-9131
Mailing Address - Country:US
Mailing Address - Phone:509-828-3760
Mailing Address - Fax:
Practice Address - Street 1:16171 N BRINSON ST
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-5509
Practice Address - Country:US
Practice Address - Phone:208-442-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist