Provider Demographics
NPI:1891902482
Name:EMMONS, PENNY SUE (COTA-L)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:SUE
Last Name:EMMONS
Suffix:
Gender:F
Credentials:COTA-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7074 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-1891
Mailing Address - Country:US
Mailing Address - Phone:515-334-9528
Mailing Address - Fax:
Practice Address - Street 1:5900 PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1569
Practice Address - Country:US
Practice Address - Phone:515-270-2205
Practice Address - Fax:515-276-0140
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00034224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant