Provider Demographics
NPI:1568610533
Name:BENTINGANAN, AMY J (MS,OTR/L)
Entity Type:Individual
Prefix:MR
First Name:AMY
Middle Name:J
Last Name:BENTINGANAN
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4804 GARDEN GROVE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-9765
Mailing Address - Country:US
Mailing Address - Phone:573-225-4300
Mailing Address - Fax:
Practice Address - Street 1:4804 GARDEN GROVE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-9765
Practice Address - Country:US
Practice Address - Phone:573-225-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007011307172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker