Active NPI
Penny Lori Bennett, COTA
- Occupational Therapy Assistant
- Waco, TX
National Provider Identifier
1982175220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 211418
- Practice address
- 2401 Development Blvd
Waco, TX 76705-2903 - Phone
- (512) 799-7339
- NPI assigned
- Dec 16, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 211418 | TX | Primary |
Addresses
Primary practice location
2401 Development Blvd
Waco, TX 76705-2903
Mailing address
2401 Development Blvd
Waco, TX 76705-2903
Phone (512) 799-7339
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NA | Other | NO IDENTIFIER NO AVAILABLE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 211418 | TX | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1544918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1544918400000",
"number": "1982175220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2401 DEVELOPMENT BLVD",
"city": "WACO",
"state": "TX",
"postal_code": "767052903",
"telephone_number": "512-799-7339"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2401 DEVELOPMENT BLVD",
"city": "WACO",
"state": "TX",
"postal_code": "767052903",
"telephone_number": "512-799-7339"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "PENNY",
"middle_name": "LORI",
"name_prefix": "Mrs.",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-16",
"last_updated": "2018-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "TX",
"license": "211418",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NO IDENTIFIER NO AVAILABLE",
"identifier": "NA",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.