Individual
MR. S. BRIAN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
1034 N 500 W, PROVO, UT 84604-3380
(801) 357-7475
(801) 357-7997
Mailing address
PO BOX 25537, SALT LAKE CITY, UT 84125-0537
(801) 357-1250
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5110123-4201
UT
225X00000X
Occupational Therapist
Primary
51101234201
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51101234201
UTAH STATE LICENSE
UT
Enumeration date
08/01/2006
Last updated
04/30/2026
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