Provider Demographics
NPI:1215163126
Name:BENNETT, KERI LYNN (OTR/L)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:LYNN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2299 METROPOLIS ST
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960-1320
Mailing Address - Country:US
Mailing Address - Phone:618-524-2634
Mailing Address - Fax:
Practice Address - Street 1:2299 METROPOLIS ST
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960-1320
Practice Address - Country:US
Practice Address - Phone:618-524-2634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006881225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist