Provider Demographics
NPI:1568634178
Name:PENNINGTON, PEGGY GWEN
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:GWEN
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:42743-0220
Mailing Address - Country:US
Mailing Address - Phone:270-932-4211
Mailing Address - Fax:270-932-3504
Practice Address - Street 1:202 - 206 MILBY STREET
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743
Practice Address - Country:US
Practice Address - Phone:270-932-4211
Practice Address - Fax:270-932-3504
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKYR1116225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist