Individual
SHAUNA MARIE BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1115 W CHESTNUT ST, BROCKTON, MA 02301-7501
(508) 521-2200
Mailing address
1094 ADAMS ST, DORCHESTER CENTER, MA 02124-5702
(617) 823-9554
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
13490
MA
Other
Enumeration date
10/20/2021
Last updated
10/20/2021
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