MEDICARE: MISS COURTNEY BENTLEY LSW, CAA

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	104100000X	Social Worker	S1303480	OH

General Provider Information

NPI Number	:	1912309006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS COURTNEY BENTLEY LSW, CAA

Provider Business Mailing Address
First Line	:	5400 EDALBERT DRIVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-7695
Country	:	US
Telephone Number	:	513-741-3100
Fax Number	:	513-741-5686

Provider Business Practice Location Address
First Line	:	3131 S DIXIE DR
Second Line	:	SUITE 220
City	:	MORAINE
State	:	OH
Zip	:	45439-2256
Country	:	US
Telephone Number	:	937-643-0398
Fax Number	:	937-643-0398

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

Provider Enumeration Date	:	09/19/2014
Last Update Date	:	09/19/2014

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