MEDICARE: CHARLOTTE BENSTINE OTR/L

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	056.014641	IL

General Provider Information

NPI Number	:	1487309563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE BENSTINE OTR/L

Provider Business Mailing Address
First Line	:	1052 N OAKLEY BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3587
Country	:	US
Telephone Number	:	630-240-3641
Fax Number	:

Provider Business Practice Location Address
First Line	:	2211 N ELSTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2918
Country	:	US
Telephone Number	:	630-240-3641
Fax Number	:

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

Provider Enumeration Date	:	02/16/2022
Last Update Date	:	02/16/2022

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Directions to “ CHARLOTTE BENSTINE OTR/L” Practice Location

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