Individual
BILLIE JEAN BENTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
501 N LAKE ST, PESHTIGO, WI 54157-1013
(715) 582-3906
Mailing address
1408 23RD ST, MENOMINEE, MI 49858-2300
(906) 863-1599
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1737-27
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41072000
—
WI
Enumeration date
08/05/2008
Last updated
08/05/2008
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