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General NPI Number Information
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NPI Number | 1629671516
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Entity Type | Individual
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Provider Name | ELIZABETH ANNE BENEDETTI-WEBER OTR/L
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Gender | Female
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Dates
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Enumeration Date | 11/21/2020
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 44201 DEQUINDRE RD
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City | TROY
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State | MI
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Zip | 48085-1117
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Country | US
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Telephone | 248-964-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 27424 GRANT ST
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-3422
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Country | US
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Telephone | 248-703-1445
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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 | 5201010839
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License Number State | MI
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