Provider Demographics
NPI:1245453505
Name:PENSE, GLORIA JEAN (OT)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:JEAN
Last Name:PENSE
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 1:19 BILLINGSLEY DR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-5542
Mailing Address - Country:US
Mailing Address - Phone:479-220-0756
Mailing Address - Fax:
Practice Address - Street 1:19 BILLINGSLEY DR
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72714-5542
Practice Address - Country:US
Practice Address - Phone:479-220-0756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1669225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist