Healthcare Provider Details

I. General information

NPI: 1699366534
Provider Name (Legal Business Name): GABRIELLE BENNETT OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E AIRPORT RD
OKMULGEE OK
74447-9082
US

IV. Provider business mailing address

3734 SOUTH AVE STE E
SPRINGFIELD MO
65807-5291
US

V. Phone/Fax

Practice location:
  • Phone: 918-495-4110
  • Fax:
Mailing address:
  • Phone: 417-839-4318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5649
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: