Healthcare Provider Details

I. General information

NPI: 1487764346
Provider Name (Legal Business Name): MARWYN G BENEMERITO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 TIMBER CREEK DR SUITE 101
CORDOVA TN
38018-4234
US

IV. Provider business mailing address

1044 CROSS WOOD LN
CORDOVA TN
38018-6604
US

V. Phone/Fax

Practice location:
  • Phone: 901-309-5219
  • Fax: 901-309-5265
Mailing address:
  • Phone: 901-309-5219
  • Fax: 901-309-5265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5112
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number955
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3892
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2379
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3275
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3278
License Number StateTN

VIII. Authorized Official

Name: MR. MARWYN GARIBAY BENEMERITO
Title or Position: OWNER / OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 901-309-5219