=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477008340
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COURTNEY LYNNE BENNER MOT, OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2016
-----------------------------------------------------
Last Update Date | 05/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 511 N 12TH ST E
-----------------------------------------------------
City | RIVERTON
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82501-3805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-438-1768
-----------------------------------------------------
Fax | 307-460-5791
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 511 N 12TH ST E
-----------------------------------------------------
City | RIVERTON
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82501-3805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-438-1768
-----------------------------------------------------
Fax | 307-460-5791
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Occupational Therapist
-----------------------------------------------------
License Number | 9834370-4201
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 9834370-4201
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 9834370-4201
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------