Provider Demographics
NPI:1982841474
Name:MARTIN, PENNY SUE (OT)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:SUE
Last Name:MARTIN
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 1:142 JENKINS MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:WELLSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45692-9561
Mailing Address - Country:US
Mailing Address - Phone:740-384-3039
Mailing Address - Fax:
Practice Address - Street 1:142 JENKINS MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:OH
Practice Address - Zip Code:45692-9561
Practice Address - Country:US
Practice Address - Phone:740-384-3039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist