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NPI Code Detail

MEDICARE: MS. GENEVIEVE ROXANNE PENLAND MHS, OTR/L

MEDICARE:  MS. GENEVIEVE ROXANNE PENLAND  MHS, OTR/L
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
1225XP0200XPediatric Occupational Therapist1885SC

General Provider Information

NPI Number : 1821451022
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. GENEVIEVE ROXANNE PENLAND MHS, OTR/L
Provider Business Mailing Address
First Line : 16 OTTER TRAIL CT
Second Line :
City : COLUMBIA
State : SC
Zip : 29203-9284
Country : US
Telephone Number : 803-269-2056
Fax Number :
Provider Business Practice Location Address
First Line : 3620 COVENANT RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29204-4216
Country : US
Telephone Number : 803-787-3033
Fax Number : 803-787-0300
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2016
Last Update Date : 04/04/2016

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Directions to “ MS. GENEVIEVE ROXANNE PENLAND MHS, OTR/L” Practice Location

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