Provider Demographics
NPI:1609329820
Name:BAGELMAN, PENNY LEE
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:LEE
Last Name:BAGELMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PARK VISTA DR UNIT 2084
Mailing Address - Street 2:APT. 2084
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-3030
Mailing Address - Country:US
Mailing Address - Phone:516-640-7794
Mailing Address - Fax:
Practice Address - Street 1:3230 S BUFFALO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2505
Practice Address - Country:US
Practice Address - Phone:516-640-7794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2016-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor