Provider Demographics
NPI:1477008340
Name:BENNER, COURTNEY LYNNE (MOT, OTR/L)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:LYNNE
Last Name:BENNER
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:LYNNE
Other - Last Name:SCHAFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L,
Mailing Address - Street 1:511 N 12TH ST E
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-3805
Mailing Address - Country:US
Mailing Address - Phone:307-438-1768
Mailing Address - Fax:307-460-5791
Practice Address - Street 1:511 N 12TH ST E
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-3805
Practice Address - Country:US
Practice Address - Phone:307-438-1768
Practice Address - Fax:307-460-5791
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9834370-4201225XM0800X, 225XP0200X, 225X00000X, 225XP0200X, 225X00000X
IDOT-1654225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID225X00000XMedicaid
UT3008546Medicaid