Individual
LYNETTE L BENBACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
513 6TH ST NW, LEW WALLACE ES, ALBUQUERQUE, NM 87102-2005
(505) 848-9409
Mailing address
513 6TH ST NW, LEW WALLACE ES, ALBUQUERQUE, NM 87102-2005
(505) 848-9409
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1546
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B 8255
—
NM
Enumeration date
01/22/2007
Last updated
07/09/2007
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