Healthcare Provider Details

I. General information

NPI: 1740529262
Provider Name (Legal Business Name): JANICE BENCE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 BATTLEFIELD RD
GROTTOES VA
24441-4300
US

IV. Provider business mailing address

1508 BATTLEFIELD RD
GROTTOES VA
24441-4300
US

V. Phone/Fax

Practice location:
  • Phone: 540-363-6539
  • Fax:
Mailing address:
  • Phone: 540-363-6539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119000746
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: