Provider Demographics
NPI:1770105991
Name:PENEGOR, BRITTANY ANN (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:BRITTANY
Middle Name:ANN
Last Name:PENEGOR
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 1:400 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:ONTONAGON
Mailing Address - State:MI
Mailing Address - Zip Code:49953-1614
Mailing Address - Country:US
Mailing Address - Phone:906-884-6054
Mailing Address - Fax:
Practice Address - Street 1:601 S 7TH ST
Practice Address - Street 2:
Practice Address - City:ONTONAGON
Practice Address - State:MI
Practice Address - Zip Code:49953-1448
Practice Address - Country:US
Practice Address - Phone:906-884-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010601225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist