Provider Demographics
NPI:1275676850
Name:BENNETT, CAROLYN BARBARA (OTRL)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:BARBARA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:BARBARA
Other - Last Name:OCONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:25 PROFFITT ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-3434
Mailing Address - Country:US
Mailing Address - Phone:931-265-3745
Mailing Address - Fax:931-520-3754
Practice Address - Street 1:25 PROFFITT ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3434
Practice Address - Country:US
Practice Address - Phone:931-265-3745
Practice Address - Fax:931-520-3754
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT3274225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist