Individual
KRISTEN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
400 CRATER LAKE AVE, MEDFORD, OR 97504-6808
(541) 613-6505
Mailing address
400 CRATER LAKE AVE, MEDFORD, OR 97504-6808
(541) 613-6505
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
334935
OR
Other
Enumeration date
05/09/2019
Last updated
03/13/2025
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