Individual
FANOR BENAVIDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
35 SHAWMUT AVE, LA GRANGE, IL 60525-8648
(708) 206-9899
Mailing address
2824 HARVEY AVE, BERWYN, IL 60402-2705
(773) 510-5182
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.005735
IL
Other
Enumeration date
04/24/2024
Last updated
04/24/2024
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