Individual
JESSICA DALE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
6401 OHIO DR, PLANO, TX 75024-6700
(214) 556-4530
Mailing address
1360 N 13TH ST APT 28C, CORSICANA, TX 75110-3071
(903) 851-6670
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
214203
TX
Other
Enumeration date
10/05/2016
Last updated
10/05/2016
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