Provider Demographics
NPI:1609031947
Name:PENNINGTON, MELISSA LITTLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LITTLE
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 BRIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-9336
Mailing Address - Country:US
Mailing Address - Phone:252-443-7667
Mailing Address - Fax:252-451-8136
Practice Address - Street 1:160 S WINSTEAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3419
Practice Address - Country:US
Practice Address - Phone:252-443-7667
Practice Address - Fax:252-451-8136
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6621225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist