Healthcare Provider Details

I. General information

NPI: 1336473743
Provider Name (Legal Business Name): CASSANDRA D BENNETT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N FALER AVE
PINEDALE WY
82941
US

IV. Provider business mailing address

PO BOX 1037
PINEDALE WY
82941-1037
US

V. Phone/Fax

Practice location:
  • Phone: 307-367-6236
  • Fax: 307-367-3332
Mailing address:
  • Phone: 307-367-6236
  • Fax: 307-367-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTR-767
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: