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Organization

GULF COAST THERAPY ASSOCIATES, P.A.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. THEESA C BENOCK O.T.R.C.H.T. (OCCUPATIONAL THERAPIST)
(941) 624-6222
Entity
Organization

Contact information

Practice address
3417 TAMIAMI TRL STE A, PORT CHARLOTTE, FL 33952-8158
(941) 624-6222
(941) 624-6831
Mailing address
12576 BACCHUS RD, PORT CHARLOTTE, FL 33981-1509
(941) 698-1191

Taxonomy

Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
OT1055
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
R6F
BCBS
FL
Enumeration date
05/22/2007
Last updated
08/22/2020
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