Provider Demographics
NPI:1629234638
Name:BENNETT, JOANNA CLAIRE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:CLAIRE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5699 FAIRWOOD DR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4681
Mailing Address - Country:US
Mailing Address - Phone:770-218-9678
Mailing Address - Fax:
Practice Address - Street 1:26 TOWER RD NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-6947
Practice Address - Country:US
Practice Address - Phone:678-797-6000
Practice Address - Fax:770-794-3546
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003984225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist