Kelly Pennock, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

Practice address

1739 Kirby Rd
MC Lean, VA 22101-4817

Phone

(800) 451-5121

NPI assigned

Jan 17, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516147200000",
    "number": "1851809420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2238 WHITCOMB PL",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220461852",
            "telephone_number": "540-840-2247",
            "fax_number": "540-840-2247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1739 KIRBY RD",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221014817",
            "telephone_number": "800-451-5121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNOCK",
        "first_name": "KELLY",
        "credential": "COTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-17",
        "last_updated": "2018-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "VA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pelex Medical of Virginia
• Pelex, Inc
• Courtnee Ann Pelton, PSY.D.
• Jillian Grace Pelzer, LPC
• Kimberlyn Nicole Pena
• Robert Fitzgerald Pereddo, LPTA
• Aloysius C Pereira, MD
• Ella Peresechenski, MD
• Perfect Storm
• Kimberly Ann Perks

• Occupational Therapy Assistant in MC Lean, VA
• Providers in MC Lean, VA by specialty
• Occupational Therapy Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 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.

Verify at the official NPI Registry.