Individual
MRS. TEAL BENEVIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., OTRL
Contact information
Practice address
902 CHERRY WOOD CT, PHOENIXVILLE, PA 19460-4851
(703) 209-4473
Mailing address
902 CHERRY WOOD CT, PHOENIXVILLE, PA 19460-4851
(703) 209-4473
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OC009708
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1015242300001
MEDICAL ASSISTANCE NUMBER
PA
Enumeration date
05/28/2007
Last updated
07/08/2007
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