Provider Demographics
NPI:1437722329
Name:BENNETT, JOSHUA (OTR/L)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:M
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 1:424 SW 27TH AVE BLDG 6105
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-2099
Mailing Address - Country:US
Mailing Address - Phone:847-370-0442
Mailing Address - Fax:
Practice Address - Street 1:2890 SW 73RD WAY APT 1307
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-1018
Practice Address - Country:US
Practice Address - Phone:847-370-0442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
FL21985225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist