MEDICARE: MS. PENNY SUE CLEMENS O.T.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	39	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OTA 39	OTHER	CA	COTA

General Provider Information

NPI Number	:	1063628048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PENNY SUE CLEMENS O.T.A.

Provider Business Mailing Address
First Line	:	31584 AGOURA RD # 3 BLD 10
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-4442
Country	:	US
Telephone Number	:	818-631-8541
Fax Number	:

Provider Business Practice Location Address
First Line	:	31584 AGOURA RD # 3 BLD 10
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-4442
Country	:	US
Telephone Number	:	818-631-8541
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	05/31/2026

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