Provider Demographics
NPI:1851467070
Name:BENNETT, REBECCA E (OTR)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:E
Last Name:BENNETT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5415 N SHERIDAN RD
Mailing Address - Street 2:3014
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1954
Mailing Address - Country:US
Mailing Address - Phone:773-944-1167
Mailing Address - Fax:
Practice Address - Street 1:5225 OLD ORCHARD RD
Practice Address - Street 2:SUITE 18
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4405
Practice Address - Country:US
Practice Address - Phone:847-663-1020
Practice Address - Fax:847-663-1022
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007868225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics