MEDICARE: DAVID HECTOR BENAVIDES OTR

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

General Provider Information

NPI Number	:	1457984007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID HECTOR BENAVIDES OTR

Provider Business Mailing Address
First Line	:	2932 BUENA PARK RD
Second Line	:
City	:	BURLINGTON
State	:	WI
Zip	:	53105-7949
Country	:	US
Telephone Number	:	262-903-1504
Fax Number	:

Provider Business Practice Location Address
First Line	:	10340 WASHINGTON AVE
Second Line	:
City	:	STURTEVANT
State	:	WI
Zip	:	53177-1607
Country	:	US
Telephone Number	:	262-687-7500
Fax Number	:

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

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	02/21/2020

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Directions to “ DAVID HECTOR BENAVIDES OTR” Practice Location

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