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General NPI Number Information
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NPI Number | 1760540140
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Entity Type | Individual
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Provider Name | BENJIE ACOSTA LETRAN OT
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 803 SE PLAZA AVE
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City | BENTONVILLE
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State | AR
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Zip | 72712-7772
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Country | US
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Telephone | 479-636-1270
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Fax |
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Provider Business Mailing Address
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Address Line | 1519 S.20TH ST.
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City | ROGERS
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State | AR
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Zip | 72758
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Country | US
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Telephone | 479-636-1270
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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 | OTR1830
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License Number State | AR
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