Individual
BENJIE ACOSTA LETRAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
803 SE PLAZA AVE, BENTONVILLE, AR 72712-7772
(479) 636-1270
Mailing address
1519 S.20TH ST., ROGERS, AR 72758
(479) 636-1270
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR1830
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5Y831
ABCBS
AR
Enumeration date
12/05/2006
Last updated
07/08/2007
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