Active NPI
Penny Lorie Short, OTRL
- Occupational Therapist
- Maiden, NC
National Provider Identifier
1942312871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 6028
- Practice address
- 240 Hartzoge LN
Maiden, NC 28650-8342 - Phone
- (704) 736-5279
- Fax
- (828) 428-9502
- NPI assigned
- Aug 31, 2006
- Last updated
- Jul 8, 2016
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 6028 | NC | Primary |
Addresses
Primary practice location
240 Hartzoge LN
Maiden, NC 28650-8342
Mailing address
240 Hartzoge LN
Maiden, NC 28650-8342
Phone (704) 736-5279
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| TH1697 | Medicaid | SC | |
| 721634 | 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 |
|---|---|---|---|
| 6028 | NC | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467936000000",
"number": "1942312871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "240 HARTZOGE LN",
"city": "MAIDEN",
"state": "NC",
"postal_code": "286508342",
"telephone_number": "704-736-5279",
"fax_number": "828-428-9502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "240 HARTZOGE LN",
"city": "MAIDEN",
"state": "NC",
"postal_code": "286508342",
"telephone_number": "704-736-5279",
"fax_number": "828-428-9502"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHORT",
"first_name": "PENNY",
"middle_name": "LORIE",
"name_prefix": "Ms.",
"credential": "OTRL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2016-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "6028",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "TH1697",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "721634",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maiden, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.