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General NPI Number Information
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NPI Number | 1366094484
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Entity Type | Individual
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Provider Name | STEPHEN CARL BENNETT OCCUPATIONAL THERAPI
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Gender | Male
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Dates
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Enumeration Date | 07/09/2019
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Last Update Date | 07/09/2019
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Provider Practice Location Address
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Address Line | 300 NORTH AVE
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City | BATTLE CREEK
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State | MI
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Zip | 49017-3307
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Country | US
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Telephone | 269-245-8125
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Fax |
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Provider Business Mailing Address
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Address Line | 182 GREGG DR
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City | BATTLE CREEK
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State | MI
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Zip | 49014-7829
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Country | US
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Telephone | 269-419-4917
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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