Provider Demographics
NPI:1033233200
Name:BENDURE, CONNIE SUE (OTA)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:SUE
Last Name:BENDURE
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 GARTH CIR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-1373
Mailing Address - Country:US
Mailing Address - Phone:330-966-0734
Mailing Address - Fax:
Practice Address - Street 1:2300 GRAYBILL RD
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-8119
Practice Address - Country:US
Practice Address - Phone:330-899-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA-01540224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant