MEDICARE: MS. GINA MICHELE BENAVENTE DHSC, MPH, 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	107590	TX
2	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1639158215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GINA MICHELE BENAVENTE DHSC, MPH, OTR

Provider Business Mailing Address
First Line	:	6705 COVERED BRIDGE DR UNIT 23
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78736-3313
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6705 COVERED BRIDGE DR UNIT 23
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78736-3313
Country	:	US
Telephone Number	:	512-200-1206
Fax Number	:

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	03/02/2022

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