Healthcare Provider Details

I. General information

NPI: 1366750879
Provider Name (Legal Business Name): DONNA MARIE PENO MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 DIXON AVE
CONCORD NH
03301-4944
US

IV. Provider business mailing address

P.O. BOX 779
CONCORD NH
03301
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-1551
  • Fax:
Mailing address:
  • Phone: 603-224-1551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: