Individual
GARY DALE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
2701 CHESTNUT STATION CT, LOUISVILLE, KY 40299-6395
(800) 335-1060
Mailing address
4051 CREEK WAY APT 45, INDIANAPOLIS, IN 46227-4046
(317) 865-1335
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32003204A
IN
Other
Enumeration date
07/18/2017
Last updated
03/17/2018
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