Provider Demographics
NPI:1275802761
Name:BENDER, CASEY JO (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:JO
Last Name:BENDER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:JO
Other - Last Name:VANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1106 PARK DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:64034-9344
Mailing Address - Country:US
Mailing Address - Phone:660-620-2605
Mailing Address - Fax:
Practice Address - Street 1:1106 PARK DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MO
Practice Address - Zip Code:64034-9344
Practice Address - Country:US
Practice Address - Phone:660-620-2605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011001388224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant