Active NPI
Jennifer Anne Pennington, OTR CHT
- Hand Occupational Therapist
- Raleigh, NC
National Provider Identifier
1356386205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hand Occupational Therapist
- License
- 3963
- Practice address
- 8001 T W Alexander Dr
Raleigh, NC 27617-4883 - Phone
- (919) 232-5020
- Fax
- (919) 235-0610
- NPI assigned
- Jun 17, 2006
- Last updated
- Nov 8, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hand Occupational Therapist | 225XH1200X | 4608 | NC | |
| Hand Occupational Therapist | 225XH1200X | 3963 | CO | Primary |
Addresses
Primary practice location
8001 T W Alexander Dr
Raleigh, NC 27617-4883
Mailing address
204 Tellico PL
Cary, NC 27519-6010
Phone (919) 417-4115
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4608 | Other | NC | LICENSE NO. |
| 3963 | Other | CO | CO OT LICENSE |
| 136M2 | Other | NC | BCBS PROVIDER ID |
| 7301721 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4608 | NC | MD | Mental Health Counselor |
| 3963 | CO | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carolina Complete Rehab Center of Hope Mills Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapist
- Hope Mills, NC
- NPI 1144270372
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541635200000",
"number": "1356386205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "204 TELLICO PL",
"city": "CARY",
"state": "NC",
"postal_code": "275196010",
"telephone_number": "919-417-4115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8001 T W ALEXANDER DR",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276174883",
"telephone_number": "919-232-5020",
"fax_number": "919-235-0610"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNINGTON",
"first_name": "JENNIFER",
"middle_name": "ANNE",
"credential": "OTR CHT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-17",
"last_updated": "2018-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "225XH1200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Hand",
"state": "NC",
"license": "4608",
"primary": false
},
{
"code": "225XH1200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Hand",
"state": "CO",
"license": "3963",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NO.",
"identifier": "4608",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CO OT LICENSE",
"identifier": "3963",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER ID",
"identifier": "136M2",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7301721",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.