Provider Demographics
NPI:1043515836
Name:PENLAND, JENNIFER L (OTR/L, MSOT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:PENLAND
Suffix:
Gender:F
Credentials:OTR/L, MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 MISTY BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-6465
Mailing Address - Country:US
Mailing Address - Phone:502-507-3841
Mailing Address - Fax:
Practice Address - Street 1:127 MISTY BROOKE DR
Practice Address - Street 2:
Practice Address - City:MOUNT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-6465
Practice Address - Country:US
Practice Address - Phone:502-507-3841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR4588225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist