MEDICARE: LAURA PENNINGTON MOSONYI MS OTR

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	0119003341	VA

General Provider Information

NPI Number	:	1043714611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA PENNINGTON MOSONYI MS OTR

Provider Business Mailing Address
First Line	:	502 MONTGOMERY DR
Second Line	:
City	:	RUTHER GLEN
State	:	VA
Zip	:	22546-1138
Country	:	US
Telephone Number	:	703-786-2140
Fax Number	:

Provider Business Practice Location Address
First Line	:	16261 RICHMOND TPKE
Second Line	:
City	:	BOWLING GREEN
State	:	VA
Zip	:	22427-2203
Country	:	US
Telephone Number	:	804-633-5088
Fax Number	:

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

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	03/20/2018

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