Healthcare Provider Details

I. General information

NPI: 1568610533
Provider Name (Legal Business Name): AMY J BENTINGANAN MS,OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4804 GARDEN GROVE DR
COLUMBIA MO
65203-9765
US

IV. Provider business mailing address

4804 GARDEN GROVE DR
COLUMBIA MO
65203-9765
US

V. Phone/Fax

Practice location:
  • Phone: 573-225-4300
  • Fax:
Mailing address:
  • Phone: 573-225-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number2007011307
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: