Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 4368 | CA |
NPI | 1184928145 |
---|---|
Provider Name | Ms. Loretta Bennett |
First Address | Inglewood, CA 90301-3734 |
Second Address | Inglewood, CA 90301-3734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2011 |
Last Update Date | 06/01/2011 |