MEDICARE: TONYA S BENZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	3877-26	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3877-26	OTHER	WI	OT

General Provider Information

NPI Number	:	1104848688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONYA S BENZ

Provider Business Mailing Address
First Line	:	6369 GOOSE LAKE DR
Second Line	:	COMPLIANCE MAIL CODE-2433
City	:	VERONA
State	:	WI
Zip	:	53593-9255
Country	:	US
Telephone Number	:	608-848-1632
Fax Number	:

Provider Business Practice Location Address
First Line	:	6369 GOOSE LAKE DR
Second Line	:	COMPLIANCE MAIL CODE-2433
City	:	VERONA
State	:	WI
Zip	:	53593-9255
Country	:	US
Telephone Number	:	608-848-1632
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/08/2007

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Directions to “ TONYA S BENZ ” Practice Location

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