Provider Demographics
NPI:1902778285
Name:PENNIX, KHAYLA
Entity type:Individual
Prefix:
First Name:KHAYLA
Middle Name:
Last Name:PENNIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 GABLES DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4996
Mailing Address - Country:US
Mailing Address - Phone:804-508-6499
Mailing Address - Fax:804-324-2998
Practice Address - Street 1:1040 GABLES DR
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4996
Practice Address - Country:US
Practice Address - Phone:804-508-6499
Practice Address - Fax:804-324-2998
Is Sole Proprietor?:No
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics