Provider Demographics
NPI:1811295769
Name:BENNETT, PETER (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:BENNETT
Suffix:
Gender:M
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 COGSWELL ST STE C24
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2740
Mailing Address - Country:US
Mailing Address - Phone:321-872-8737
Mailing Address - Fax:
Practice Address - Street 1:1535 COGSWELL ST STE C24
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2740
Practice Address - Country:US
Practice Address - Phone:321-872-8737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT5157225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist