MEDICARE: RACHELLE C BENNIE OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	2536	CA

General Provider Information

NPI Number	:	1093754061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHELLE C BENNIE OTR/L

Provider Business Mailing Address
First Line	:	PO BOX 8520
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92375-1720
Country	:	US
Telephone Number	:	909-557-1600
Fax Number	:	909-557-1740

Provider Business Practice Location Address
First Line	:	1901 W LUGONIA AVE
Second Line	:	SUITE 130
City	:	REDLANDS
State	:	CA
Zip	:	92374-9703
Country	:	US
Telephone Number	:	909-557-1600
Fax Number	:	909-557-1740

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	07/13/2007

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