Provider Demographics
NPI:1063700557
Name:MANUEL, PENNY L (OT)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:L
Last Name:MANUEL
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 1:1504 LOWER BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463-8016
Mailing Address - Country:US
Mailing Address - Phone:318-335-2706
Mailing Address - Fax:337-468-4692
Practice Address - Street 1:1504 LOWER BEAVER RD
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463-8016
Practice Address - Country:US
Practice Address - Phone:318-335-2706
Practice Address - Fax:337-468-4692
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z12317225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist