Healthcare Provider Details

I. General information

NPI: 1255240420
Provider Name (Legal Business Name): GRACE MARIE DEBENEDICT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 10TH AVE
BELMAR NJ
07719-2317
US

IV. Provider business mailing address

10 NANCY CT
JACKSON NJ
08527-4669
US

V. Phone/Fax

Practice location:
  • Phone: 732-910-9196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR01311200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: