Individual
DANA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/ L
Contact information
Practice address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 257-5758
Mailing address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 257-5758
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.003529
IL
Other
Enumeration date
01/30/2019
Last updated
01/30/2019
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