MEDICARE: WENDY BENNETT

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	225XP0019X	Physical Rehabilitation Occupational Therapist	3670	MA

General Provider Information

NPI Number	:	1326497033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY BENNETT

Provider Business Mailing Address
First Line	:	64 RIVER ST
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-2122
Country	:	US
Telephone Number	:	774-454-6321
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 N PARK AVE
Second Line	:	SUITE 1300
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-4090
Country	:	US
Telephone Number	:	508-830-0999
Fax Number	:

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

Provider Enumeration Date	:	06/03/2016
Last Update Date	:	06/03/2016

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