Provider Demographics
NPI:1871068809
Name:BENTLEY, OLIVIA LAUREN (OTR/L)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:LAUREN
Last Name:BENTLEY
Suffix:
Gender:F
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 1:2308 GLEN FOREST DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2791
Mailing Address - Country:US
Mailing Address - Phone:513-967-4826
Mailing Address - Fax:
Practice Address - Street 1:716 E CEDAR ROCK ST
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-2324
Practice Address - Country:US
Practice Address - Phone:864-878-4739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5113225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist