Healthcare Provider Details

I. General information

NPI: 1043714611
Provider Name (Legal Business Name): LAURA PENNINGTON MOSONYI MS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16261 RICHMOND TPKE
BOWLING GREEN VA
22427-2203
US

IV. Provider business mailing address

502 MONTGOMERY DR
RUTHER GLEN VA
22546-1138
US

V. Phone/Fax

Practice location:
  • Phone: 804-633-5088
  • Fax:
Mailing address:
  • Phone: 703-786-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119003341
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: