Provider Demographics
NPI:1821871773
Name:BENNETT, ELENA MARIE
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:MARIE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 S PERRY PARK RD
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:CO
Mailing Address - Zip Code:80135-8207
Mailing Address - Country:US
Mailing Address - Phone:720-441-9329
Mailing Address - Fax:
Practice Address - Street 1:4218 S PERRY PARK RD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:CO
Practice Address - Zip Code:80135-8207
Practice Address - Country:US
Practice Address - Phone:720-441-9329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOTA.0001617224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant