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NPI Code Detail

MEDICARE: MRS. JENNIFER SUE BENNETTS MOT, OTR/L

MEDICARE: MRS. JENNIFER SUE BENNETTS MOT, OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist2002012023MO

General Provider Information

NPI Number : 1093949026
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER SUE BENNETTS MOT, OTR/L
Provider Business Mailing Address
First Line : 7501 PROSPECT AVE
Second Line :
City : KANSAS CITY
State : MO
Zip : 64132-2103
Country : US
Telephone Number : 816-421-5848
Fax Number : 816-237-2065
Provider Business Practice Location Address
First Line : 7501 PROSPECT AVE
Second Line :
City : KANSAS CITY
State : MO
Zip : 64132-2103
Country : US
Telephone Number : 816-421-5848
Fax Number : 816-237-2065
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2009
Last Update Date : 05/05/2009

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