Provider Demographics
NPI:1497573604
Name:BENDER, SALLY MARIE
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:MARIE
Last Name:BENDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 243
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:WV
Mailing Address - Zip Code:26601-0243
Mailing Address - Country:US
Mailing Address - Phone:304-644-5516
Mailing Address - Fax:
Practice Address - Street 1:3492 SAND LICK RD
Practice Address - Street 2:
Practice Address - City:FLATWOODS
Practice Address - State:WV
Practice Address - Zip Code:26621
Practice Address - Country:US
Practice Address - Phone:304-644-5516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant