Provider Demographics
NPI:1780441394
Name:BENTLEY, BRIANNA ALEXIS (OTR)
Entity type:Individual
Prefix:MISS
First Name:BRIANNA
Middle Name:ALEXIS
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 COUNTY ROAD 565
Mailing Address - Street 2:
Mailing Address - City:CAULFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65626-7212
Mailing Address - Country:US
Mailing Address - Phone:417-372-1046
Mailing Address - Fax:
Practice Address - Street 1:105 S BLAIR ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4410
Practice Address - Country:US
Practice Address - Phone:479-259-2339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3912225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist