Individual
BENNET PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, OTR/L
Contact information
Practice address
10222 74TH ST STE 211, KENOSHA, WI 53142-6810
(262) 925-5020
(262) 925-5021
Mailing address
3921 30TH AVE STE C, KENOSHA, WI 53144-1957
(262) 925-5004
(262) 925-5001
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
6674-26
WI
Other
Enumeration date
08/28/2011
Last updated
06/05/2020
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