Basic Information
| Provider Information | |||||||||
| NPI: | 1811295769 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENNETT | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OTD, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1535 COGSWELL ST STE C24 | ||||||||
| Address2: | |||||||||
| City: | ROCKLEDGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329552740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218728737 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1535 COGSWELL ST STE C24 | ||||||||
| Address2: | |||||||||
| City: | ROCKLEDGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329552740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218728737 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2011 | ||||||||
| LastUpdateDate: | 08/28/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT5157 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.