MEDICARE: MRS. OLIVE D BENNETT-WRIGHT SPECIAL ED TEACHER

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
1	174400000X	Specialist	18968	NY

General Provider Information

NPI Number	:	1215364450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. OLIVE D BENNETT-WRIGHT SPECIAL ED TEACHER

Provider Business Mailing Address
First Line	:	1829 ROCKAWAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5005
Country	:	US
Telephone Number	:	718-942-4130
Fax Number	:

Provider Business Practice Location Address
First Line	:	1829 ROCKAWAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5005
Country	:	US
Telephone Number	:	718-942-4130
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2013
Last Update Date	:	10/02/2013

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