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NPI Code Detail

MEDICARE: KAY D BENJAMIN OTR

MEDICARE: KAY D BENJAMIN 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
1225X00000XOccupational Therapist115132TX
2225X00000XOccupational Therapist2573NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1886T09OTHERBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558453506
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAY D BENJAMIN OTR
Provider Business Mailing Address
First Line : PO BOX 2603 HTN, CLIENT ACCOUNTING
Second Line :
City : FT. WORTH
State : TX
Zip : 76113-2603
Country : US
Telephone Number : 817-569-4300
Fax Number :
Provider Business Practice Location Address
First Line : 3840 HULEN ST HTN, CLIENT ACCOUNTING
Second Line :
City : FT. WORTH
State : TX
Zip : 76107-7277
Country : US
Telephone Number : 817-569-4300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 06/12/2013

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