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General NPI Number Information
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NPI Number | 1386312221
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Entity Type | Individual
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Provider Name | JUSTINE MEUNIER FIEBELKORN BENAVENTE OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/03/2021
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 1125 SIR FRANCIS DRAKE BLVD
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City | KENTFIELD
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State | CA
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Zip | 94904-1418
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Country | US
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Telephone | 415-485-3555
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Fax |
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Provider Business Mailing Address
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Address Line | 711 VIA CASITAS
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City | GREENBRAE
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State | CA
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Zip | 94904-1814
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Country | US
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Telephone | 415-531-8929
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 14344
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License Number State | CA
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