Provider Demographics
NPI:1851330419
Name:BENNETT, MARY DIANE (CTRS)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:DIANE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 MERION TRCE
Mailing Address - Street 2:APT. B-214
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-1742
Mailing Address - Country:US
Mailing Address - Phone:215-823-4449
Mailing Address - Fax:
Practice Address - Street 1:7200 MERION TRCE
Practice Address - Street 2:APT. B-214
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-1742
Practice Address - Country:US
Practice Address - Phone:215-823-4449
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist