Provider Demographics
NPI:1376984534
Name:BENNETTS, BRIANNA CAROLE (OTR)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:CAROLE
Last Name:BENNETTS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:CAROLE
Other - Last Name:SMYTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 775
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-0775
Mailing Address - Country:US
Mailing Address - Phone:860-605-6420
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 775
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211-0775
Practice Address - Country:US
Practice Address - Phone:860-605-6420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15459225X00000X
MEOT 2752225X00000X
MA10963225X00000X
COOT.0004563225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist