Provider Demographics
NPI:1043714611
Name:MOSONYI, LAURA PENNINGTON (MS OTR)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:PENNINGTON
Last Name:MOSONYI
Suffix:
Gender:F
Credentials:MS OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:RUTHER GLEN
Mailing Address - State:VA
Mailing Address - Zip Code:22546-1138
Mailing Address - Country:US
Mailing Address - Phone:703-786-2140
Mailing Address - Fax:
Practice Address - Street 1:16261 RICHMOND TPKE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:VA
Practice Address - Zip Code:22427-2203
Practice Address - Country:US
Practice Address - Phone:804-633-5088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003341225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist