Individual
LISA M BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
322 KRAFT ST, NEENAH, WI 54956-4986
(920) 843-2168
Mailing address
322 KRAFT ST, NEENAH, WI 54956-4986
(920) 843-2168
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5458-27
WI
Other
Enumeration date
11/26/2018
Last updated
11/26/2018
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