Healthcare Provider Details

I. General information

NPI: 1013644970
Provider Name (Legal Business Name): CHELSEA MARIE BONNIE BENITZ OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 FAIRGROUNDS RD
HAMILTON MT
59840-3126
US

IV. Provider business mailing address

1333 TOOLE AVE UNIT C23
MISSOULA MT
59802-2341
US

V. Phone/Fax

Practice location:
  • Phone: 406-375-0980
  • Fax: 406-375-9938
Mailing address:
  • Phone: 651-245-1695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7774
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: