Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT002993 | GA |
NPI | 1205172731 |
---|---|
Provider Name | Ms. Christy Bennett |
First Address | Cumming, GA 30041-5818 |
Second Address | Alpharetta, GA 30005-3948 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2013 |
Last Update Date | 03/01/2013 |