Provider Demographics
NPI:1164038477
Name:BENNETT, CHELSEA (OTD)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:
Other - Last Name:CLARKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD
Mailing Address - Street 1:471 COUNTY ROAD 381
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-8158
Mailing Address - Country:US
Mailing Address - Phone:870-270-2735
Mailing Address - Fax:
Practice Address - Street 1:726 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2854
Practice Address - Country:US
Practice Address - Phone:870-633-3305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR256389721Medicaid