Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 5037 | AL |
NPI | 1003437252 |
---|---|
Provider Name | Joseph Chase Bennett |
First Address | Birmingham, AL 35242-7099 |
Second Address | Birmingham, AL 35233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2020 |
Last Update Date | 29/04/2020 |