Provider Demographics
NPI:1215364450
Name:BENNETT-WRIGHT, OLIVE D (SPECIAL ED TEACHER)
Entity Type:Individual
Prefix:MRS
First Name:OLIVE
Middle Name:D
Last Name:BENNETT-WRIGHT
Suffix:
Gender:F
Credentials:SPECIAL ED TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 ROCKAWAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5005
Mailing Address - Country:US
Mailing Address - Phone:718-942-4130
Mailing Address - Fax:
Practice Address - Street 1:1829 ROCKAWAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5005
Practice Address - Country:US
Practice Address - Phone:718-942-4130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18968174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist