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General NPI Number Information
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NPI Number | 1225789761
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Entity Type | Individual
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Provider Name | SHARMISHA BENJAMIN
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Gender | Female
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Dates
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Enumeration Date | 01/17/2022
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Last Update Date | 01/17/2022
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Provider Practice Location Address
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Address Line | 1900 N 14TH STREET
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City | HERRIN
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State | IL
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Zip | 62948-6294
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Country | US
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Telephone | 618-942-7391
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Fax |
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Provider Business Mailing Address
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Address Line | 207 3RD STREET
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City | COLP
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State | IL
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Zip | 62918
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Country | US
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Telephone | 618-925-2767
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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 | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | 057005256
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License Number State |
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