Healthcare Provider Details

I. General information

NPI: 1942522867
Provider Name (Legal Business Name): AMY LEEANN BENECK OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10981 MEADS
ORANGE CA
92869-2112
US

IV. Provider business mailing address

10981 MEADS
ORANGE CA
92869-2112
US

V. Phone/Fax

Practice location:
  • Phone: 714-322-7510
  • Fax:
Mailing address:
  • Phone: 714-322-7510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number6418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: