MEDICARE: ANDREA BENO OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	102007	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HP43201	OTHER	FM	MN HEALTHPARTNERS NUMBER
2	685S7MA	OTHER	MN	MN BCBS NUMBER
3	7616187	OTHER	MN	MN AETNA NUMBER

General Provider Information

NPI Number	:	1083686851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA BENO OTR/L

Provider Business Mailing Address
First Line	:	8830 NORMANDALE BLVD
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55437-1051
Country	:	US
Telephone Number	:	952-758-5775
Fax Number	:	952-758-5778

Provider Business Practice Location Address
First Line	:	314 MAIN ST E
Second Line	:	SUITE 3
City	:	NEW PRAGUE
State	:	MN
Zip	:	56071-2448
Country	:	US
Telephone Number	:	952-758-5775
Fax Number	:	952-758-5778

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	07/09/2007

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Directions to “ ANDREA BENO OTR/L” Practice Location

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