Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 12664 | NC |
NPI | 1235808387 |
---|---|
Provider Name | Mark A Bennett |
First Address | Sanford, NC 27332-2382 |
Second Address | Carthage, NC 28327-9338 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2021 |
Last Update Date | 12/09/2021 |