MEDICARE: LISA MARIE BENEVIDES

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	224Z00000X	Occupational Therapy Assistant	OTA00090	RI

General Provider Information

NPI Number	:	1770232407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE BENEVIDES

Provider Business Mailing Address
First Line	:	65 COLEMAN ST
Second Line	:
City	:	SWANSEA
State	:	MA
Zip	:	02777-2101
Country	:	US
Telephone Number	:	774-319-1307
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 COLEMAN ST
Second Line	:
City	:	SWANSEA
State	:	MA
Zip	:	02777-2101
Country	:	US
Telephone Number	:	774-319-1307
Fax Number	:

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

Provider Enumeration Date	:	03/21/2022
Last Update Date	:	12/22/2025

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Directions to “ LISA MARIE BENEVIDES ” Practice Location

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