MEDICARE: DB GOODLIFE LLC

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	225XP0200X	Pediatric Occupational Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386443117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DB GOODLIFE LLC

Provider Business Mailing Address
First Line	:	3310 OAKWELL CT APT 32302
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-5113
Country	:	US
Telephone Number	:	925-250-7178
Fax Number	:

Provider Business Practice Location Address
First Line	:	3310 OAKWELL CT APT 32302
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-5113
Country	:	US
Telephone Number	:	210-256-9859
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OCCUPATIONAL THERAPIST
Name	:	DENNISE M BENAVIDES
Credential	:	OTR, MOT
Telephone Number	:	925-250-7178

Provider Enumeration Date	:	03/12/2025
Last Update Date	:	03/12/2025

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Directions to “DB GOODLIFE LLC ” Practice Location

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