Provider Demographics
NPI:1356386205
Name:PENNINGTON, JENNIFER ANNE (OTR CHT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:OTR CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 TELLICO PL
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6010
Mailing Address - Country:US
Mailing Address - Phone:919-417-4115
Mailing Address - Fax:
Practice Address - Street 1:8001 T W ALEXANDER DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-4883
Practice Address - Country:US
Practice Address - Phone:919-232-5020
Practice Address - Fax:919-235-0610
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4608225XH1200X
CO3963225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4608OtherLICENSE NO.
CO3963OtherCO OT LICENSE
NC136M2OtherBCBS PROVIDER ID
NC7301721Medicaid
NC4608OtherLICENSE NO.