Healthcare Provider Details

I. General information

NPI: 1174296446
Provider Name (Legal Business Name): BRIANNA BENTON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2021
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 LINGLESTOWN RD STE 2
HARRISBURG PA
17112-1153
US

IV. Provider business mailing address

4033 LINGLESTOWN RD STE 2
HARRISBURG PA
17112-1153
US

V. Phone/Fax

Practice location:
  • Phone: 717-920-5002
  • Fax:
Mailing address:
  • Phone: 717-920-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC017861
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: