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General NPI Number Information
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NPI Number | 1184824195
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Entity Type | Individual
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Provider Name | CARLA JUNE BENBROOK COTA/L
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Gender | Female
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 07/19/2007
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Provider Practice Location Address
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Address Line | SHADY LAWN 2582 CERULEAN RD
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City | CADIZ
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State | KY
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Zip | 42211
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Country | US
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Telephone | 270-522-3236
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Fax | 270-522-0825
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Provider Business Mailing Address
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Address Line | PO BOX 161
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City | CROFTON
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State | KY
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Zip | 42217-0161
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Country | US
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Telephone | 270-424-5843
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | A3592
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License Number State | KY
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