Basic Information
| Provider Information | |||||||||
| NPI: | 1629194022 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENNETT | ||||||||
| FirstName: | KRISTINA | ||||||||
| MiddleName: | MARIA | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 232 | ||||||||
| Address2: | |||||||||
| City: | GREEN LANE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180540232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152342862 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1700 PINE ST | ||||||||
| Address2: | |||||||||
| City: | NORRISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194013040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102397100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OP009214 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.