Individual
MARY HART BENECKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31007374A
IN
225XP0200X
Pediatric Occupational Therapist
8749
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001631599
ANTHEM PTAN
IN
05
—
300058594
—
IN
Enumeration date
10/05/2017
Last updated
08/22/2025
Update your record
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