Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA002113 | GA |
NPI | 1023570595 |
---|---|
Provider Name | Brittany Alexis Bennett |
First Address | Atlanta, GA 30341-1271 |
Second Address | Cartersville, GA 30120-2848 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2019 |
Last Update Date | 03/04/2019 |