Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT2432 | CA |
NPI | 1063896249 |
---|---|
Provider Name | Catherine Bennett |
First Address | Ventura, CA 93001-3005 |
Second Address | Ventura, CA 93001-3005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2015 |
Last Update Date | 17/07/2015 |