Individual
SHAD W BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2195 W CHANDLER BLVD STE 180, CHANDLER, AZ 85224
(809) 963-9339
(480) 963-4098
Mailing address
2195 W CHANDLER BLVD STE 180, CHANDLER, AZ 85224-6580
(809) 963-9339
(480) 963-4098
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
007975
AZ
Other
Enumeration date
11/12/2019
Last updated
11/19/2019
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