Individual
JENNIFER ANNE PENNINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR CHT
Contact information
Practice address
8001 T W ALEXANDER DR, RALEIGH, NC 27617-4883
(919) 232-5020
(919) 235-0610
Mailing address
204 TELLICO PL, CARY, NC 27519-6010
(919) 417-4115
Taxonomy
Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
Primary
3963
CO
225XH1200X
Hand Occupational Therapist
4608
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136M2
BCBS PROVIDER ID
NC
01
—
3963
CO OT LICENSE
CO
01
—
4608
LICENSE NO.
NC
05
—
7301721
—
NC
Enumeration date
06/17/2006
Last updated
11/08/2018
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