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General NPI Number Information
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NPI Number | 1710598818
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Entity Type | Individual
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Provider Name | PENELOPE YOOSOOK OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/12/2020
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 217 E BREMER AVE
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City | WAVERLY
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State | IA
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Zip | 50677-3435
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Country | US
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Telephone | 800-268-7192
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Fax |
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Provider Business Mailing Address
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Address Line | 1272 SE BROWNSTONE WAY
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City | WAUKEE
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State | IA
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Zip | 50263-8798
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Country | US
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Telephone | 307-259-9175
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-1513
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 108774
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License Number State | IA
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