Provider Demographics
NPI:1124716717
Name:BENNETT, LILLYN MARIE (LOTR, CLT, CFPS)
Entity type:Individual
Prefix:
First Name:LILLYN
Middle Name:MARIE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LOTR, CLT, CFPS
Other - Prefix:
Other - First Name:LILLYN
Other - Middle Name:M
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LOTR, CLT, CFPS
Mailing Address - Street 1:4460 HODGES BLVD APT 417
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-5205
Mailing Address - Country:US
Mailing Address - Phone:504-669-1188
Mailing Address - Fax:
Practice Address - Street 1:4460 HODGES BLVD APT 417
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-5205
Practice Address - Country:US
Practice Address - Phone:504-669-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11331225XP0019X
PAOC013958225XP0019X
FLOT12110225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation