Provider Demographics
NPI:1952414062
Name:MCSPADDEN, PENNY RENEE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:RENEE
Last Name:MCSPADDEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:AR
Mailing Address - Zip Code:72111-9631
Mailing Address - Country:US
Mailing Address - Phone:501-849-2120
Mailing Address - Fax:
Practice Address - Street 1:2200 FORT ROOTS DR # 117/NLR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-3015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1047225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist