Provider Demographics
NPI:1922366152
Name:BENNETT, BETH SARA (MA, OTRL)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:SARA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MA, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2303
Mailing Address - Country:US
Mailing Address - Phone:516-569-3083
Mailing Address - Fax:516-374-1185
Practice Address - Street 1:620 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2303
Practice Address - Country:US
Practice Address - Phone:516-569-3083
Practice Address - Fax:516-374-1185
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0129271111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health