Individual
SHELLY BENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1710 SMEDE HWY, SAINT MARTINVILLE, LA 70582-7703
(337) 608-7636
Mailing address
100 SANDY BROOK LN, LAFAYETTE, LA 70508-5349
(318) 525-6131
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
Z11883
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z11883
LOUISIANA STATE BOARD OF MEDICAL EXAMINERS
LA
Enumeration date
04/12/2018
Last updated
04/12/2018
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