Provider Demographics
NPI:1245425933
Name:BENNETT, SUSAN NICOLE (MOTRL)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:NICOLE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 15C
Mailing Address - Street 2:BARBOUR COUNTY GOOD SAMARITAN CENTER
Mailing Address - City:BELINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26250-9422
Mailing Address - Country:US
Mailing Address - Phone:304-823-1791
Mailing Address - Fax:304-823-1934
Practice Address - Street 1:RR 3 BOX 15C
Practice Address - Street 2:BARBOUR COUNTY GOOD SAMARITAN CENTER
Practice Address - City:BELINGTON
Practice Address - State:WV
Practice Address - Zip Code:26250-9422
Practice Address - Country:US
Practice Address - Phone:304-823-1791
Practice Address - Fax:304-823-1934
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1273225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist