Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 3670 | MA |
NPI | 1326497033 |
---|---|
Provider Name | Wendy Bennett |
First Address | Plymouth, MA 02360-2122 |
Second Address | Plymouth, MA 02360-4090 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2016 |
Last Update Date | 03/06/2016 |