Gary Dale Bennett, COTA
Individual provider Active NPI Occupational Therapy Assistant · Louisville, KY
NPI 1295258705 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1295258705
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 32003204A (IN)
- Practice address
- 2701 Chestnut Station CT
Louisville, KY 40299-6395 - Phone
- (800) 335-1060
- NPI assigned
- Jul 18, 2017
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32003204A | IN | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 32003204A | IN | Yes |
Addresses
Primary practice location
2701 Chestnut Station CT
Louisville, KY 40299-6395
Mailing address
4051 Creek Way Apt 45
Indianapolis, IN 46227-4046
Phone (317) 865-1335
Other practice location 1
8405 Clearvista Pl
Indianapolis, IN 46256-3737
Phone (317) 578-7500
Other providers in Louisville, KY
- Alona Bennett
- Audrey Bennett
- Christine Bennett
- Deborah Sue Bennett
- Donald Walter Bennett
- Jacqueline Hilda Bennett
- James Francis Bennett
- Jasmin Nicole Bennett
- Jeanne Marie Bennett
- Jesslyn Bennett
All providers in Louisville, KY · Occupational Therapy Assistant in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.