Provider Demographics
NPI:1871635201
Name:BENTLEY, JENNIFER L (OTR)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:NEILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:708 CANTEBURY DR
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-3116
Mailing Address - Country:US
Mailing Address - Phone:660-747-7770
Mailing Address - Fax:
Practice Address - Street 1:708 CANTEBURY DR
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-3116
Practice Address - Country:US
Practice Address - Phone:660-747-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999137823225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist