Provider Demographics
NPI:1598576191
Name:BENGTSON, PAIGE NICOLE (COTA/L)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:NICOLE
Last Name:BENGTSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 GALLERIA PKWY SE STE 500
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3188
Mailing Address - Country:US
Mailing Address - Phone:888-899-1331
Mailing Address - Fax:
Practice Address - Street 1:2000 NE 64TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-3703
Practice Address - Country:US
Practice Address - Phone:816-321-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-01959224Z00000X
MO2024006737224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant