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Individual

EMILY E BENEDICT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
2615 HARRISON ST, BELLWOOD, IL 60104-2450
(708) 493-0199
(708) 493-9683
Mailing address
2615 HARRISON ST, BELLWOOD, IL 60104-2450
(708) 493-0199
(708) 493-9683

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057-003197
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
057-003197
IL LIC #
IL
Enumeration date
04/28/2010
Last updated
04/28/2010
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