Individual
MS. SHAWNETTE BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
25951 147TH DR, ROSEDALE, NY 11422-2925
(347) 292-7241
Mailing address
25951 147TH DR, ROSEDALE, NY 11422-2925
Taxonomy
Speciality
Code
Description
License number
State
224ZE0001X
Environmental Modification Occupational Therapy Assistant
Primary
006811
NY
Other
Enumeration date
10/26/2017
Last updated
10/26/2017
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