MEDICARE: PENNY ALSUP 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
1	225X00000X	Occupational Therapist	0119010927	VA

General Provider Information

NPI Number	:	1861803793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PENNY ALSUP OTR/L

Provider Business Mailing Address
First Line	:	112 SAVAGE DR
Second Line	:
City	:	RUSTBURG
State	:	VA
Zip	:	24588-3950
Country	:	US
Telephone Number	:	815-601-4950
Fax Number	:

Provider Business Practice Location Address
First Line	:	20212 LEESVILLE RD
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-3669
Country	:	US
Telephone Number	:	847-441-5593
Fax Number	:

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

Provider Enumeration Date	:	05/13/2014
Last Update Date	:	04/07/2026

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