MEDICARE: JENNIFER L PENLAND OTR/L, MSOT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	R4588	KY

General Provider Information

NPI Number	:	1043515836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L PENLAND OTR/L, MSOT

Provider Business Mailing Address
First Line	:	127 MISTY BROOKE DR
Second Line	:
City	:	MOUNT WASHINGTON
State	:	KY
Zip	:	40047-6465
Country	:	US
Telephone Number	:	502-507-3841
Fax Number	:

Provider Business Practice Location Address
First Line	:	127 MISTY BROOKE DR
Second Line	:
City	:	MOUNT WASHINGTON
State	:	KY
Zip	:	40047-6465
Country	:	US
Telephone Number	:	502-507-3841
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2011
Last Update Date	:	10/09/2012

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