Individual
AUTUMN LEE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 E 17TH ST, BLOOMINGTON, IN 47408-1590
(517) 331-4654
Mailing address
3521 BREEZY POINT DR, OKEMOS, MI 48864-5967
(517) 331-4654
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36003760A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
MI
Other
Enumeration date
08/19/2021
Last updated
07/07/2023
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